Sarah Montgomery
Decaturville,Tennessee
Summary
Medical professional with thorough understanding of medical review processes and regulatory compliance. Known for precise documentation evaluation and improving quality assurance methodologies. Reliable team collaborator focused on achieving impactful results and adapting to dynamic work environments. Skilled in critical analysis and clear communication.
Experienced with comprehensive medical documentation review and compliance verification. Utilizes critical analysis to identify discrepancies and ensure accuracy. Knowledge of effective communication techniques to streamline processes and enhance team collaboration.
Experienced medical professional with strong background in clinical review and analysis. Known for collaborative teamwork and achieving impactful results in dynamic environments. Skilled in medical documentation, regulatory compliance, and quality assurance. Adaptable, reliable, and ready to contribute to advancing healthcare standards.
Knowledgeable reviewer with solid background in evaluating medical documentation and ensuring compliance with regulatory standards. Proven track record of identifying discrepancies and enhancing review processes to maintain high-quality standards. Demonstrated ability in critical analysis and effective communication.
Methodical reviewer provides administrative and clerical support to medical staff. Proven record of accurately organizing, filing and retrieving patient information. Experienced in coding medical records and entering data into patient databases.
Overview
25
25
years of professional experience
Work History
Medical reviewer III
CGS administrators
12.2019 - Current
- My primary responsibilities include reviewing claims once submitted to CMS for payment
- Assessing the submitted documentation to evaluate if the information meets current LCD policy requirements and if not complete applying the appropriate DEN code for denial
- I also have experience in the appeals process
- I review claims that were previously missing information
- After the review, I decide on the resubmitted information to determine if claim is payable or not
- Enhanced overall team performance by promoting collaboration and sharing best practices among Medical Reviewers, resulting in improved efficiency and consistency in work processes.
- Conducted root cause analysis for adverse event reports, implementing corrective actions to prevent future occurrences.
- Worked closely with Data Management teams for accurate data interpretation in order to minimize discrepancies found in reports.
- Provided expert guidance on regulatory requirements, contributing to timely submissions of high-quality documents.
Case manager
arete consulting
02.2019 - 12.2019
- I worked as a workman’s comp case manager in Jackson and Nashville TN
- I was responsible for accompanying the Injured Worker to his/her office visits in which I would assess and evaluate the visit with the MD
- I would provide coordination of care, case management for whatever needs the Injured Worker would need and facilitate a timely return to the workplace
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
Case manager
AIC Consulting
09.2017 - 01.2018
- I worked for agency that involved contract work for Health Integrated
- I was responsible for managing 150—200 members in a dual special needs plan
- I made phone calls to members to help educate them on their diagnoses, assess their needs and provide teaching related to those needs and develop a plan of care to follow member for 6 months
Care coordinator
united healthcare
06.2010 - 10.2016
- I served as a point of contact for all physical, behavioral and other home and community-based services
- Conducted thorough and objective initial and ongoing face-to-face assessments of the member within specific mandatory intervals to determine status and needs including physical and behavioral, functional, psychosocial and financial and health status expectation
- Conducted telephonic outreach and complete other additional assessments as needed to address member change in condition
- Acted as an advocate for individuals care needs by identifying and addressing functional deficits and gaps in care
Case manager
Hope medical management
01.2008 - 01.2010
- Responsible for managing 50-60 members under the home and community-based waiver program
- Coordinated care and provided interdisciplinary care to help members receive optimal assistance and care while staying independent in their home
staff nurse
quality home healthcare
01.2000 - 01.2006
- Worked as staff nurse where I completed home visits daily and evaluated patients
- Provided skilled care if needed, collaborated with physician of any changes, completed the necessary paperwork for continued care and provided teaching
Education
Bachelors science degree - nursing
baptist college of health sciences
05.2000
Skills
- Fast learner
- Disciplined
- Excellent verbal skills
- Excellent written skills
- Comfortable working in multiple computer systems
- Home office
- High-speed internet
- Patient Safety
- Ethics and integrity
- Clinical research experience
- Medical Writing
Timeline
Medical reviewer III
CGS administrators
12.2019 - Current
Case manager
arete consulting
02.2019 - 12.2019
Case manager
AIC Consulting
09.2017 - 01.2018
Care coordinator
united healthcare
06.2010 - 10.2016
Case manager
Hope medical management
01.2008 - 01.2010
staff nurse
quality home healthcare
01.2000 - 01.2006
Bachelors science degree - nursing
baptist college of health sciences
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