SHERNONN F. JASMIN
Summary
Experienced professional with 20+ years in outpatient clinics, hospitals, nursing homes, and rehabilitation centers. Proven track record of surpassing targets in fast-paced environments. Strategic thinker skilled in pre-authorization procedures, patient care management, insurance guidelines, and medical terminology for efficient medical authorization processing and effective healthcare communication.
Overview
16
16
years of professional experience
Work History
LVN Pre/Authorization Nurse Auditor
Harris Health System
09.2019 - Current
- Obtains authorizations for scheduled outpatient appointments, special procedures, tests, injections and higher-level services.
- Provides pertinent clinical information in a timely manner according to third party payer guidelines.
- Evaluates the medical necessity for inpatient hospital admission and Outpatient appointments reviews the authorization of the services or admission along with the estimated length of stay utilizing nationally recognized screening criteria.
- Identifies issues that are impacting initial, continued stay, high level service and outpatient service authorizations.
- Facilitates peer to peer review between the clinical staff and the payer for denied admissions/length of stay and outpatient services.
- Participates in monthly departmental payer Provider Representative meetings.
- Maintains all authorization information on the Auth/Cert screens in EPIC. Information is to be specific enough to assist in the tracking and managing of denials.
- Retrieves medical record information or any other clinical information needed for appealing the claim or denial of services.
- Participates in required Authorization education.
- Ensures that existing and new workqueues are worked appropriately.
- Maintains current knowledge of literature, trends, standards, state/federal regulations that are pertinent to the authorization process.
LVN
UT Physicians Multi-Specialty Clinic
10.2015 - 09.2019
- Telephone Triage and assist with medication refill request.
- Contacts appropriate insurance personnel to complete pre-authorizations for certain medications and or DME supplies.
- Contacts appropriate insurance personnel to pre-certify tests ordered by the physicians with practice's EMR procedure (Allscripts and Centricity)
- Complete all necessary documentation in the patient's medical record in accordance with practice's EMR procedure (Allscripts and Centricity)
- Assist with the completion of NAIP forms for provider (Psychologist/PCP) meetings
- Assist Physicians in completing documentation received from any Medical Ancillary Services or any forms submitted by patients.
- Submit charges for nurse visits, injections/vaccinations, pulmonary testing and/or diagnostic testing.
- Research and resubmit missing charges for billing.
- Assist in the assessments of patient needs and health plan by taking vital signs, patient history, record and update medication list, assessing visual acuity & determining chief complaints.
- Administer prescribed injections, nebulizer treatments and vaccinations.
- Perform EKG, Urinalysis, Spirometry Testing, Glucose, Hemoglobin A1C, Strep, Flu, Pregnancy and Ear Irrigation, Wound Care.
LVN FRONT AND BACK OFFICE
Memorial Hermann Medical Group
06.2013 - 10.2015
- Good communication, interpersonal and organizational skills
- Maintained stock of supplies and placed orders as required.
- Ability to handle billing and insurance matters and coordinate with respective insurance carriers.
- Assisted front office by scheduling follow up and new patient appointments.
- Skilled in working with medical database and applications (E Clinical and Care 4)
- Ensured that patient's records were updated in a timely manner.
- Obtained pre-authorizations and pre-certifications for testing, outpatient procedure, medications, and DME supplies.
- Contacted patients to inform them of test results.
- Provided patient with follow up care instructions.
- Telephone Triage and assisted with medication refill request.
- Prepared patient for medical examinations
- Assisted Physician in completing documentations received from any Medical Ancillary Services or any forms submitted by patients.
- Submit charges for injections, vaccinations, pulmonary testing and/or diagnostic testing.
- Performed initial patient assessment before physician arrived in exam room.
- Ensured that all rooms were cleaned before and after each appointment.
- Skillfully performed suture and or staple removals for patients
- Administered injections, medications and perform office procedures (EKG, Urinalysis, Glucose, Strep, Flu, Pregnancy and Spirometry testing)
- Performed wound care.
FIELD NURSE (PRN)
Serenity Health Services
02.2013 - 06.2013
- Performed accurate assessments and communicate effectively with patients, families, and physicians.
- Documented patient status in an accurate and timely manner.
- Addressed patient's needs and problems, nursing intervention and patient response, safety intervention, education and teaching.
- Administered all medications and treatments according to agency policy and procedure, accepted standards of care and agency guidelines
CLINICAL REVIEW NURSE
Health Help
02.2012 - 12.2012
- Analyzed, review and report on charts, charting trends, and quality assurance indicators.
- Phoned physician's office to obtain required medical documentation.
- Updated and coordinate with the supervising nurse and external clinical staff regarding charges in the patients' treatment plans when necessary.
- Monitored compliance to policies and procedures including but not limited to clinical documentation.
- Resolved charting issues and recommend changes to procedures.
- Updated corrections on documentation after retrieval from appointed nurse(s)
- Assisted the quality department with surveys and audits as assigned.
- Assisted with professional education activities to encourage professional skill proficiency for all agency clients.
- Participated as a consultant in the implementation of chart review tools, standards of care, and outcome measures.
PRE-CERTIFICATION NURSE
Texas Health Spring
05.2011 - 02.2012
- Performed telephone referrals
- Communicated with Physician offices and facilities to provide patient care.
- Evaluated patient medical records using Medicare Guidelines.
- Computer entry using EZ CAP/CCMS
- Responsible for reviewing organizations pre-service request and process the authorizations and denials by using Milliman Guidelines & InterQual Criteria
- Submitted referrals that could not be approve to Medical Directors for review
UNIT MANAGER
Regent Care Center of Kingwood
09.2009 - 04.2011
- Met with all staff supervisors once a month to identify and address issues.
- Maintained records of physical, mental and psychosocial care of residents.
- Developed and implemented new policies and procedures based on resident's needs.
- Scheduled nursing staff and addressed any payroll issues.
- Prepared reports on residents' conditions and informed medical staff of any issues
- Implemented and executed quality control procedures to ensure optimal resident care.
- Maintained detailed resident medication records according to doctor's order.
- Manage nursing staff and prepared all shift schedules.
- Ensured compliance with regulations and standards through regular audits, staff education, and policy updates.
- Resolved conflicts among team members quickly to maintain a positive working environment conducive for continued excellence in patient care.
- Oversaw RNs, LPNs, nursing aides, medical clerks and support staff and performed staffing scheduling duties.
- Part of committee responsible for interviewing and hiring nursing staff
- Collaborated with interdisciplinary care team to develop resident care plans.
- Responded to visitors and family member inquires in a timely courteous manner.
- Ensured nursing staff function in accordance with legislation and common law affecting nursing practice.
- Maintained clinical competence by assisting on assigned unit & continuing education.
- Provided support for the Director of Nursing & assist with solving problems.
Education
Certificate - MSHBC CPC Study Group
University of Texas Health Science Center-Houston
08.2019
Bachelor of Business Administration - Management
Our Lady of the Lake University
05.2017
Certificate of Completion - Licensed Practical Nursing Program
Louisiana Technical College
12.2003
Skills
- Twenty-one years of healthcare experience
- Multi-specialty medical practice
- HIPAA compliance
- Knowledge of regulatory standards, compliance requirements, hospital policies and procedures
- Knowledge of Medicare and Medicaid
- Multi-tasking and prioritization
- Attention to detail
- Case Management
- Excellent administrative, clinical and patient assessment skills
Timeline
LVN Pre/Authorization Nurse Auditor
Harris Health System
09.2019 - Current
LVN
UT Physicians Multi-Specialty Clinic
10.2015 - 09.2019
LVN FRONT AND BACK OFFICE
Memorial Hermann Medical Group
06.2013 - 10.2015
FIELD NURSE (PRN)
Serenity Health Services
02.2013 - 06.2013
CLINICAL REVIEW NURSE
Health Help
02.2012 - 12.2012
PRE-CERTIFICATION NURSE
Texas Health Spring
05.2011 - 02.2012
UNIT MANAGER
Regent Care Center of Kingwood
09.2009 - 04.2011
Bachelor of Business Administration - Management
Our Lady of the Lake University
Certificate of Completion - Licensed Practical Nursing Program
Louisiana Technical College
Certificate - MSHBC CPC Study Group
University of Texas Health Science Center-Houston
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