Shalli Henson
Onalaska,WI
Summary
Utilization management specialist with extensive experience in medical necessity reviews and healthcare compliance at Gundersen Health System. Demonstrated success in optimizing patient resource utilization through strategic provider collaboration. Proficient in clinical data management, ensuring HIPAA compliance while providing actionable insights to enhance patient care.
Overview
26
26
years of professional experience
Work History
Utilization Management Specialist
Gundersen Health System
11.2017 - Current
- Monitored medical necessity for inpatient or outpatient care levels.
- Consulted with medical staff on medical level of care determinations to ensure appropriate patient care and resource utilization
- Ensured compliance with internal and external policies and procedures, including regulatory and legal requirements for denial and appeals processes
- Collaborated with HIM to ensure staff complied with HIPAA regulations for ROI and blanket authorizations.
- Works collaboratively, primarily with other Gundersen Utilization Management Department, Social Services, Care Coordination, physicians, medical directors, Admission Referral Coordination Center, Quality, hospital nurses, clinical managers, and other medical center personnel
- Documented outcomes of medical necessity reviews in department database, capturing results of external audits and insurance company denials and appeals
Clinical Data Registrar
Gundersen Health System
11.2014 - 11.2017
- EHR review of roughly 200 charts monthly, abstracting specific data required for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.
- Ensured compliance with database requirements and timely submission of deadlines.
- Generated quarterly reports for Bariatric Team to support decision-making.
- Presented Semiannual Bariatric Report at departmental meetings to inform stakeholders.
Health Documentation Specialist
Gundersen Health System
09.2012 - 11.2014
- Conducted quality assurance of health record data by comparing dictated and transcribed data, delivering actionable feedback to enhance data accuracy.
- Supported transcription and dictation processes for physicians/providers, ensuring optimal functionality of dictation devices.
- Compiled and submitted daily dictation and transcription reports to HIT staff for review and analysis.
- Engaged in daily communication with healthcare providers to address inquiries and provide support. with healthcare providers verbally and via email.
Medical Transcriptionist
Gundersen Health System
03.2000 - 09.2012
- Transcribed medical records for 12 departments, including inpatient, outpatient, and behavioral health, ensuring accurate documentation.
- Transcription quality of 99% or above.
- Performed transcription tasks remotely, showcasing reliability and commitment to quality work.
Education
Certified Metabolic and Bariatric Surgical Clinical Reviewer -
09-2015
Registered Health Information Technologist -
06-2015
A.A.S. - Health Information Technology
Western Technical College
La Crosse, WI04-2015
Skills
- Necessity review
- Denial management
- Healthcare compliance
- HIPAA compliance
- Resource utilization
- Clinical data management
- Provider collaboration
Military Service
U.S. Navy Reserves, Heavy Equipment Operator, 04/90, 04/98, Honorable, E5
Timeline
Utilization Management Specialist
Gundersen Health System
11.2017 - Current
Clinical Data Registrar
Gundersen Health System
11.2014 - 11.2017
Health Documentation Specialist
Gundersen Health System
09.2012 - 11.2014
Medical Transcriptionist
Gundersen Health System
03.2000 - 09.2012
Certified Metabolic and Bariatric Surgical Clinical Reviewer -
Registered Health Information Technologist -
A.A.S. - Health Information Technology
Western Technical College