Summary
Overview
Work History
Education
Skills
Certification
Work Availability
Websites
Accomplishments
Work Preference
Quote
Timeline
TruckDriver

Patti Carroll-Frey

Lakewood,CO

Summary

Enthusiastic and highly motivated registered nurse with 3 years’ experience as a legal nurse consultant specializing in personal injury law and 8 years’ experience as a nurse reviewer performing utilization review, insurance appeals, and auto injury summaries. Strong work ethic and a penchant for perfection.


"Hard work is its own reward." - Marcus Samuelsson

Overview

10
10
years of professional experience
1
1
Certification

Work History

Clinical Appeals Consultant – Medical Necessity

PayerWatch
04.2024 - Current
  • Conducts in-depth medical record reviews regarding opportunity for revenue recoupment
  • Provides well written appeal arguments based on clinical evidence within the medical record
  • Analyzes poorly documented medical records to glean enough evidence to write a compelling written argument to overturn the reimbursement denial
  • Provide root cause analyses and performance improvement
  • Quickly organize review activities, thoughts, analysis, writing, and uploading of completed tasks within assigned time frames

Content Writer/Subject Matter Expert

Independent Contractor
12.2022 - 03.2024
  • Edited, proofread, and fact-checked content for accuracy and clarity using industry best practices
  • Researched and wrote effective copy that was tailored to licensed nurses continuing education
  • Researched markets and queried for potential publications looking for steady content within healthcare
  • Managed time effectively to meet all responsibilities on deadline

RN, Case Manager and Utilization Review

Seeking Employment
11.2019 - 11.2022
  • During the pandemic, sought employment to utilize skills and knowledge from my diverse nursing background
  • Spent time reading medical and nursing literature regarding changes and updates in legal nurse consulting, utilization review, case management, and CMS for Medicare and Medicaid
  • Completed continuing education from various websites for nursing licenses and general career education
  • Studied to take legal nurse consultant and case management certification tests

Service Delivery Manager

Conduent
06.2019 - 10.2019
  • Developed and maintained business relationships with 40 clients who used Midas solutions
  • Coordinated weekly, biweekly, or monthly WebEx or Teams meetings with clients to discuss ongoing technical difficulties with Midas products
  • Company implemented workforce reduction. Position was eliminated after four months of employment

Utilization Review Nurse

Molina Healthcare
10.2016 - 05.2019
  • Reviewed inpatient medical records for the NICU, adult medical, and skilled nursing level of care using InterQual and MCG guidelines
  • Provided managed care company with detailed clinical information when completing admission, concurrent, and retrospective reviews
  • Referred to case management when appropriate and met weekly with Medical Directors to share inpatient status and discharge plans
  • Managed time effectively to meet all responsibilities in a timely manner

Utilization Review Nurse

Professional Services Network, Inc.
09.2015 - 09.2016
  • Performed initial and concurrent review of inpatient cases applying evidence-based criteria
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
  • Worked on team of peers who continued establishment of the Veteran Choice Program (VCP) so Veterans could receive health care from a community provider
  • Position ended when direct-hire option was rescinded following company merger

Education

Associate of Applied Science - Nursing

Umpqua Community College
Roseburg, OR

Bachelor of Science - Agriculture

Illinois State University
Normal, IL

Bachelor of Arts - Legal Studies

University of Maryland University College
College Park, MD

Master of Science - Nursing

University of Phoenix
Online
01-2027

Skills

  • Meticulous organizational/time management skills
  • Excellent analytical and critical thinking skills
  • Attention to detail
  • Excellent written communication and research skills
  • Published writer with superb writing ability
  • Efficient medical records review identifying critical medical facts
  • Experience with multiple IT platforms
  • Works independently with minimal supervision yet collaborates well

Certification

  • Colorado compact RN license
  • New York RN license
  • Illinois RN license
  • Minnesota RN license

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Accomplishments

  • Achieved complete update of all critical access hospital swing bed policies by completing review of previous policies and CMS statutory laws with accuracy and efficiency.
  • Collaborated with team of three in the development of Interdisciplinary team meetings for swing bed patients at a critical access hospital.

Work Preference

Work Type

Full TimePart Time

Work Location

Remote

Important To Me

Work-life balanceFlexible work hoursWork from home optionPaid time offPaid sick leaveCompany CultureCareer advancement

Quote

Live a life full of humility, gratitude, intellectual curiosity, and never stop learning.
Gza

Timeline

Clinical Appeals Consultant – Medical Necessity

PayerWatch
04.2024 - Current

Content Writer/Subject Matter Expert

Independent Contractor
12.2022 - 03.2024

RN, Case Manager and Utilization Review

Seeking Employment
11.2019 - 11.2022

Service Delivery Manager

Conduent
06.2019 - 10.2019

Utilization Review Nurse

Molina Healthcare
10.2016 - 05.2019

Utilization Review Nurse

Professional Services Network, Inc.
09.2015 - 09.2016

Bachelor of Science - Agriculture

Illinois State University

Bachelor of Arts - Legal Studies

University of Maryland University College

Associate of Applied Science - Nursing

Umpqua Community College

Master of Science - Nursing

University of Phoenix

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