Job Search Status
Open to workDesired start date: Open to discussion
Open To Work
QUIANA JEFFERS
MCLEANSVILLE
Work Preference
Summary
Dedicated Registered Nurse with 19 years of experience in patient care and claims evaluation. Expertise in legal documentation and claims processing, collaborating with teams to achieve accurate outcomes. Focused on enhancing operational efficiency and fostering professional growth in the healthcare sector.
Overview
21
21
years of professional experience
Work History
RN
Lebauer Endocrinology
Greensboro
09.2024 - Current
- Analyzed patient data, interpreted diagnostic tests, and developed tailored treatment plans for accurate diagnosis and effective management of endocrine disorders.
- Provided comprehensive patient care, collaborated with multidisciplinary teams, and managed complex endocrine cases to enhance treatment outcomes.
- Offered empathetic support to patients, educated on self-management techniques, and coordinated follow-up care to improve long-term health outcomes.
RN
AYN
Greensboro
09.2023 - 09.2024
- Provided compassionate care as RN at AYN, prioritized patient well-being.
- Implemented evidence-based practices, contributing to improved patient recovery rates at AYN.
- Collaborated with healthcare team to coordinate treatment plans, enhancing patient outcomes.
- Analyze patient data and symptoms to develop effective care plans.
- Drove patient satisfaction through personalized care strategies, fostering positive patient experiences.
- Streamline medication administration processes, reducing errors significantly.
MEDICAL CLAIMS REVIEWER
UnitedHealth Group, UHG
Greensboro
10.2021 - 06.2023
- Evaluated complex medical claims, ensuring fair settlements and compliance with regulations, while maintaining a keen eye for potential fraud indicators.
- Investigated questionable claims to determine payment authorization, safeguarding against potential fraud.
- Evaluated evidence with the ultimate goal of creating positive outcomes for clients' claims.
- Handled and processed a variety of claims, including facility and physician.
- Conducted thorough investigations on referred files, meeting established timeframes and resolving open claims to determine entitlement for additional payment.
- Conducted investigations on referred files to ensure timely resolution.
- Collaborated with cross-functional teams to research and resolve denied insurance claims, enhancing client satisfaction.
- Investigated and followed up on denied insurance claims to facilitate resolution.
- Maintained a thorough understanding of fraudulent and illegal practices.
M&R CLINICAL RECON RN
UHC
Greensboro
04.2017 - 10.2021
- Enhanced customer satisfaction through effective problem resolution with knowledgeable, friendly service.
- Executed instructions accurately, ensuring compliance with supervisor directives and documentation standards.
- Collaborated with diverse coworkers to achieve goals and resolve product and service-related issues.
TELEPHONIC CASE MANAGER
United Health Care, AARPSHIP
Greensboro
04.2011 - 05.2017
- Monitored and evaluated client progress compared to measurable treatment and care plan goals.
- Tracked client care and ensured follow-through to enhance service effectiveness.
- Collaborated with professionals to assess and address client needs.
- Educated clients on options to assist in making informed decisions.
- Advocated for clients to resolve medical or personal crises.
- Referred client or family to appropriate community resources to obtain support for mental or physical illness.
- Modified treatment plans to reflect changes in clients' health.
- Planned and coordinated discharge from care facility to patient's home.
REGISTERED NURSE II
Moses Cone Hospital
Greensboro
09.2008 - 03.2011
- Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
- Administered medications and treatments, monitoring patients for reactions and side effects.
- Assessed patient needs, prioritized treatment, maintained patient flows and assisted physicians with non-invasive procedures.
- Acted as patient advocate and implemented total patient care through team nursing process.
- Developed and evaluated patient care plans in collaboration with medical team to ensure comprehensive treatment.
- Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
- Maintained thorough, accurate and confidential documentation in electronic medical records.
- Provided patient and family health education focusing on self-management, prevention and wellness.
- Mentored new RNs on best practices and hospital policies to enhance quality of care.
PACU REGISTERED NURSE
Surgical Care Affiliates
Greensboro
10.2005 - 03.2011
- Delivered individualized care to post-operative patients by monitoring pain levels, checking vital signs and explaining next steps to recovery.
- Evaluated patients recovering from surgeries and coming out of anesthesia.
- Administered medications to manage progression off anesthesia medications, deal with side effects and promote recovery.
- Employed nursing best practices and clinical judgment to continuously evaluate patients' progress and employed intervention to achieve desired outcomes.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Guided patients in regaining independence by establishing clear recovery goals and providing ongoing support.
- Educated patients and families on surgery and anesthesia side effects, enhancing understanding and promoting informed decision-making.
- Ensured patient safety by rigorously checking medication dosages before administration.
Education
BACHELOR OF SCIENCE - NURSING
Winston Salem State University
Winston SalemSkills
- Claims management
- Claims assessment
- Legal Documentation
- Decision Making
- Computer Skills
- MS Office
- Excel
- Outlook
- OneNote
- MCG
- KL
- UNET
- ICUE
- Dooc360
- PIQ
- Problem Solving
- Critical Thinking
- Team Collaboration
- Communication
Languages
English, Native
Certifications
- SPICE
- BLS
- CPR
- Advanced Billing and Coding
Timeline
RN
Lebauer Endocrinology
09.2024 - Current
RN
AYN
09.2023 - 09.2024
MEDICAL CLAIMS REVIEWER
UnitedHealth Group, UHG
10.2021 - 06.2023
M&R CLINICAL RECON RN
UHC
04.2017 - 10.2021
TELEPHONIC CASE MANAGER
United Health Care, AARPSHIP
04.2011 - 05.2017
REGISTERED NURSE II
Moses Cone Hospital
09.2008 - 03.2011
PACU REGISTERED NURSE
Surgical Care Affiliates
10.2005 - 03.2011
BACHELOR OF SCIENCE - NURSING
Winston Salem State University