SONIA SELVERA

Registered nurse with a comprehensive background in delivering a full spectrum of healthcare services, adept at claim review and appeal creation. Proven expertise in identifying trends in denials and collaborating effectively with multiple departments to enhance patient outcomes. Skilled in direct patient care and case management across diverse settings, complemented by a Master of Business Administration in Healthcare Administration. Committed to leveraging clinical knowledge and business acumen to drive improvements in healthcare delivery and operational efficiency.

• Collaborated with team of appeal writers to implement AI workflow
• Trained/mentored new staff in work processes, to include Epic navigation
• Coordinated with outside departments to ensure submission of corrected claims
• Supervised team of nursing and therapy staff members (home health care).

• Review/analyze inpatient and outpatient claims, as well as payor explanation of benefits, review relevant medical records, navigate multiple payor portals, create appeal of denied claims
• Navigated patient/family member through discharge planning, facilitate care coordination needs, to include post-acute services
• Interviewed, hired, and trained new staff in electronic medical record system; disciplinary discussions, to include recommendation for termination (home health care)
• Verified professional licensing, scheduled appropriate staffing, monitored hours/billing, led weekly interdisciplinary team meeing