Sheila Richards
McMillan,MI
Summary
Hard working, detail-oriented team player with strong organizational and leadership skills, with a desire to learn new skills. Dedicated employee to current organization for over 19 years.
Various roles through out the organization have contributed to career growth and a broad knowledge base.
Overview
13
13
years of professional experience
Work History
Charge Capture Analyst and Coding Supervisor
Helen Newberry Joy Hospital
01.2019 - Current
- Chargemaster Maintenance - assuring accurate Revenue Codes, CPT Codes, and charges for charge master description.
- Write appeals for payer denials.
- Research and implement CMS guidelines in relation to charging and coding.
- Liaison between clinical staff and billing/coding.
- Create and Implement EHR clinical process.
- Review charts to ensure clinical documentation matches charges, procedure codes and revenue codes applied to claim.
- Educate departments on how role effects Revenue Cycle of facility.
- Implement formal coding audit for RHC and CAH.
Utilization Review Nurse Coordinator
Helen Newberry Joy Hospital
01.2014 - 01.2019
- Performed admission reviews and concurrent reviews for medical necessity based upon Interqual Criteria while considering each patient's unique circumstances.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
- Ensured compliance with regulations and accreditation standards
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
Licensed Practical Nurse
Helen Newberry Joy Hospital
09.2010 - 01.2014
- Cared for wounds, provided treatments, and assisted with procedures.
- Administered medications and injections and monitored patients for any adverse reactions or side effects.
- Gathered lab specimens, ordered testing, and made referrals.
- Conducted initial patient assessments, medical history, assessed patients' temperature, pulse, and blood pressure and documented in medical record to inform healthcare provider.
- Provided diagnosis information, treatment possibilities, disease management tips and wound care advice to patients, loved ones and caregivers.
- Streamlined flow of clinical tasks by maintaining clean, organized, and well-stocked nursing station.
Education
Professional Medical Coding
AAPC
03.2020
Practical Nursing Certificate - Nursing
Lake Superior State University
Sault Ste. Marie, MI08.2008
Associate of Arts - Liberal Arts
North Central Michigan College
Petoskey, MI05.1998
Skills
- Data Research and Validation
- Analytical Thinking
- Auditing and Reporting
- Utilization review
- Prior Authorization
- Accurate Documentation
- Critical Thinking
- Records analysis
- InterQual Criteria
- Decision-Making
Timeline
Charge Capture Analyst and Coding Supervisor
Helen Newberry Joy Hospital
01.2019 - Current
Utilization Review Nurse Coordinator
Helen Newberry Joy Hospital
01.2014 - 01.2019
Licensed Practical Nurse
Helen Newberry Joy Hospital
09.2010 - 01.2014
Professional Medical Coding
AAPC
Practical Nursing Certificate - Nursing
Lake Superior State University
Associate of Arts - Liberal Arts
North Central Michigan College
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