Sonja Cory
Wahpeton,ND
Summary
Accomplished Clinical Reviewer at Noridian Healthcare Solutions, leveraging clinical judgment and teamwork to enhance patient care through meticulous medical assessments and streamlined processes. Demonstrated success in improving treatment plans, supporting new hires, and ensuring regulatory compliance. Expert in patient confidentiality and multitasking, contributing to significant quality improvements in healthcare delivery.
Overview
15
15
years of professional experience
Work History
Clinical Reviewer
Noridian Healthcare Solutions
08.2008 - 01.2024
- Identified surgical patients for inclusion into database through correct application of program criteria and protocols.
- Improved patient care by conducting thorough clinical reviews and providing accurate assessments.
- Enhanced treatment plans through meticulous analysis of medical records and documentation.
- Provided training support for new hires entering the role, sharing best practices gleaned from extensive clinical review experience.
- Ensured compliance with regulatory requirements through careful adherence to established guidelines and protocols.
- Participated in ongoing professional development opportunities to continually expand knowledge and refine skillset as a Clinical Reviewer.
- Attended weekly conferences to assess data on post-operative occurrences.
- Optimized communication within the healthcare team by effectively presenting clinical review findings during meetings and consultations.
- Completed detailed documentation for each case reviewed, ensuring clarity for future reference and potential audits.
- Streamlined clinical review processes by implementing efficient data management techniques.
- Conducted comprehensive evaluations of medical necessity for various treatments, ensuring appropriate allocation of resources.
- Assisted in the development of quality improvement initiatives, contributing to better patient outcomes.
- Supported decision-making processes by providing reliable and timely clinical review findings to supervisors and team members.
- Maintained strict confidentiality regarding sensitive patient information, upholding ethical standards at all times.
- Served as a reliable resource for team members seeking guidance or clarification on complex cases, fostering a supportive and collaborative work environment.
- Used medical and clinical review guidelines and parameters to maintain consistency in MD review process, appropriate utilization levels and compliance with facility policies and procedures.
- Collaborated with healthcare providers to ensure optimal patient care, addressing any discrepancies or concerns.
- Contributed to the establishment of best practices in clinical reviewing, staying current on industry trends and research developments.
- Delivered valuable insights into treatment efficacy by comparing proposed interventions against evidence-based guidelines and criteria sets.
- Built relationships, gained alignment for clinical support and articulated questions to receive appropriate level of support from superiors and peers.
- Reduced errors in medical documentation through diligent attention to detail and consistent follow-up on discrepancies.
- Maintained accuracy, completeness, and security for medical records and health information.
- Followed up with medical staff regarding missing information in patient records.
- Demonstrated exceptional organizational skills in managing multiple cases simultaneously while maintaining high levels of accuracy and efficiency.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Verified accuracy of patient information in medical records.
- Scanned and uploaded medical records into electronic medical records system.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Reviewed medical records for completeness and filed records in alphabetic and numeric order.
- Followed exact procedures for handling transfers and other releases of medical records.
- Researched and resolved medical record discrepancies.
- Assisted in training new staff on medical record processing and filing procedures.
- Used classification manuals to gain additional knowledge of disease and diagnoses processes.
- Identified new methods to optimize medical records management.
Education
Associate of Science - Nursing
Minnesota State Community And Technical College
Moorhead, MNSkills
- Clinical judgment
- Patient confidentiality
- Clinical assessment
- Teamwork
- Customer service
- Problem-solving abilities
- Multitasking
- Reliability
Timeline
Clinical Reviewer
Noridian Healthcare Solutions
08.2008 - 01.2024
Associate of Science - Nursing
Minnesota State Community And Technical College
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