Sydney Marshall
Booneville,KY
Summary
Compassionate, dedicated, and thoughtful RN with diverse experience in various fields. Seeking a position to enhance patient care skills while delivering empathetic and dignified care. Years of experience as a nurse in the healthcare industry, cultivating strong relationships with patients and their families through empathetic communication, a respectful attitude, and exceptional patient service.
Overview
9
9
years of professional experience
Work History
UM Nurse Consultant / Team Lead
Aetna/ CVS
10.2022 - Current
- Performs audits and evaluations of patients denial and approval letters within the health plan
- Works collaboratively with doctors to discuss approvals and denials of procedures, services, and medical equipment
- Utilizing coding for specific state health plan standards such as DRG or MCG credentials
- Utilizing the center for Medicare and Medicaid with the primary physician to ensure that our insurance facility is paying adequately
- Ensuring that the primary physician is appropriately charting the primary diagnosis and secondary diagnosis to ensure that the right DRG amount is being set per inpatient visits
- Working with the on staff physicians to discuss the appropriate action for the approval or denial of needed equipment and inpatient stays through internal systems
- Speaks with ordering providers about patient information and need for the supplies, study, or procedure
- Audits and writes the conclusion letter for the patient and the refer from provider
RN Leave Coordinator
Toyota (Premise HealthCare)
07.2022 - 10.2022
- Performs duties such as providing patients health care assessments, answering questions about medical conditions or treatments, and providing them with referral if the patient requires further medical attention
- As a leave coordinator, I would ensure that when charting on each patient that the codes were adequately charted
- I would achieve this task by utilizing the most appropriate ICD-10 code, CPT code for on site procedure, and DRG regulations for our members with Medicare
- I would also work with our on site facility along with the on site providers to conduct chart reviews to ensure that the appropriate codes were being utilized during their on site assessments
- If inadequate codes were utilized we would develop a plan to to change the used code compared with national regulations (Medicaid and Medicare standards)
- As a telecommunication RN I also utilize case management duties and follow the patients’ cases to ensure that they receive the proper care
Emergency and Trauma Staff Nurse
Kentucky River Medical Center
12.2021 - 07.2022
- Within this position I am responsible for direct patient care and for developing a patient care plan after a quick and thorough evaluation of a patient’s injuries
- My Responsibilities include bone setting, blood transfusions, wound care, medication administration and much more
Clinical Nurse Manager
Family Practice Clinics
05.2020 - 12.2021
- Within this position I facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors
- As a manager I would conduct chart reviews for our providers and nurses to ensure that adequate coding was facilitated upon charting
- I would also conduct in house training to ensure that the providers and nurse have adequate knowledge of informational systems based on Medicare and Medicaid standards (MCG, Insurance Clinical Policy Bulletins, and DRG regulations)
- I also advocate for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations
REFERRAL CLERK
FAMILY PRACTICE CLINIC
06.2018 - 05.2020
- As a referral clerk, I was responsible for communicating with patients in a primary care setting to ensure that appointments were created for each patient’s necessities
- I also utilized the internal communication patient record to create encounters for patients
- This allowed for patients to have fast care created for them
URINE SPECIMEN COLLECTOR
GENETOX LABORATORIES
01.2016 - 05.2018
- Within in this position I was responsible for collecting urine specimens for clinical providers
- To allow them to utilize our reports to provide patient care
- Communication and patient direct care were the main responsibilities of this position
Education
Master of Science - Nursing Family Nurse Practitioner
Northern Kentucky University
11.2024
Bachelor of Science - Nursing
Northern Kentucky University
06.2021
Associate of Science - Nursing
Galen College of Nursing
04.2020
High School Diploma -
OWSLEY COUNTY HIGH SCHOOL
01.2014
Skills
- Medicare and Medicaid coding (CPT and ICD-10)
- MCG standards
- Clinical Policy Bulleting Knowledge
- DRG Standards and Regulations
- Oral, Written, and Communication skills
- Ability to Work Independently
- Comfort with learning and using digital tools
- Problem-solving skills
- Facilitation skills
- Analytical skills
- Patient Consultation
- Preventative Health
- Patient and Family Advocacy
- EMR/EHR
- ICD-10 Coding
- Data Entry
- Case Management
Accomplishments
- Quality Assurance- Ensured and enforced medical office compliance with HIPAA, OSHA and CLIA regulations for maximum quality and control.
- Patient Advocacy- Explained treatment procedures, medication risks, special diets and physician instructions to patients.
- Selected for two scholarships while enrolled at Owsley County High School: The William Eversole Scholarship and the Rogers Scholar scholarship.
- Certified in BLS, ACLS, POLS, and NNC.
Timeline
UM Nurse Consultant / Team Lead
Aetna/ CVS
10.2022 - Current
RN Leave Coordinator
Toyota (Premise HealthCare)
07.2022 - 10.2022
Emergency and Trauma Staff Nurse
Kentucky River Medical Center
12.2021 - 07.2022
Clinical Nurse Manager
Family Practice Clinics
05.2020 - 12.2021
REFERRAL CLERK
FAMILY PRACTICE CLINIC
06.2018 - 05.2020
URINE SPECIMEN COLLECTOR
GENETOX LABORATORIES
01.2016 - 05.2018
Bachelor of Science - Nursing
Northern Kentucky University
Associate of Science - Nursing
Galen College of Nursing
High School Diploma -
OWSLEY COUNTY HIGH SCHOOL
Master of Science - Nursing Family Nurse Practitioner
Northern Kentucky University
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