PATRICIA JONES-BLAKELEY
Wallingford,CT
Summary
Registered Nurse specializing in MDS with extensive experience in healthcare compliance and financial optimization. Proven track record in staff training on Medicare guidelines and quality improvement initiatives across multiple facilities. Adept at auditing documentation and managing care oversight to ensure adherence to regulatory standards.
Overview
1
1
Certification
12
12
years of professional experience
Work History
Director of Reimbursement
MB healthcare
12.2022 - 07.2026
- Managed Care oversight for submission of information and verification of services provided.
- PDPM maximizations, CMA, CMS, Stauffer & Meyers and Traditional Health Insurance Compliance Chart review, Appeals as needed, ALJ hearings as needed.
- Executed quality improvement plan ensuring organizational compliance.
- Review of Quality Measures and Quality improvement standards and work with team for improvement.
- Staff training on Medicare requirements and CMS changes.
- PPS, OBRA and Managed care updates and training for all interdisciplinary team members.
- Audited building transmissions to ensure adherence to documentation standards. for documentation compliance.
- Work with MDS team to help develop NTA support and the understanding of PDPM coding.
- Performed chart audits verifying accuracy of patient records across 4 facilities.
Medical Review Specialist
Empower AI
10.2022 - 01.2023
- Reviewed Med B MDS and Med A SNF claims to ensure compliance and accuracy.
- Performed detailed chart reviews to assess accuracy and completeness. for SNF post payment review.
- Conducted chart reviews, audits, and appeals for ALJ hearings to support MDS until 11/2025.
- Provided Chart audits and Reviews for 6 Facilities PDPM maximizations, CMA, CMS and Traditional Health Insurance compliance.
- ADR requests for payment under Medicare B claims for therapy, MD visits, Laboratory tests.
- Oversaw submission and verification of information for Managed Care services.
- Trained staff on Medicare requirements and CMS updates to enhance compliance.
DNS/ MDS coordinator
Wolcott View Manor /Meridian Manor
09.2014 - 10.2022
- Care and Oversight of the residents within the facility Coordinate and complete all aspects of MDS including PPS, OBRA and Managed care, Review with Managed Care for continuing stay authorization.
- Conducted comprehensive chart reviews and successfully appealed Medicare and insurance denials across multiple facilities.
- Reviewed quality measures and led quality improvement initiatives to enhance resident care standards.
- Development and implementation of the Mega Rules, Quality improvement.
- DNS Duties: Implementation of New Policies and Procedures.
- Developed and implemented strategies that maximized revenue streams for the facility.
- ALJ Hearings and chart reviews for both buildings.
- Care plan reviews and updates, scheduling of care conferences and attendance of conferences.
Education
AA - Nursing
Riverside City College
Riverside, CASkills
- Medicare oversight
- MDS EXPERT
- Managed care
- Denial management
- Appeals management
- Chart audits
- Quality assurance
- Care plan coordination
- Operational reporting
- Financial analysis
- Project management
- Staff training
- Staff development
- Stakeholder engagement
- Prioritization and planning
- Medicaid regulations
- Problem solving
Personal Information
Title: RNAC-CT
Certification
- AAPAC Certified -CT, CPR Instructor Certification
Custom
Other work experience available upon request
Timeline
Director of Reimbursement
MB healthcare
12.2022 - 07.2026
Medical Review Specialist
Empower AI
10.2022 - 01.2023
DNS/ MDS coordinator
Wolcott View Manor /Meridian Manor
09.2014 - 10.2022
AA - Nursing
Riverside City College