Taunisha Draudt, RN

Over 20 years of nursing experience specializing in various fields and populations. Extensive knowledge in Stop Loss Medical Insurance with a focus on cost containment of catastrophic medical claims, resulting in $12 million in savings over 3 years. Recently acquired valuable expertise in Hospital Revenue Cycle. Confident in bringing significant value to an organization by combining skills in Stop Loss Cost Containment and Hospital Revenue Cycle.

• Experience in medical review identifying the risk and estimating cost for both Insurance Renewal and New Business.
• Participates in medical underwriting and vendor monitoring of neonatal cases for overall impact on cost and outcomes. This includes contracting with National Transplant Networks, working with vendors on pre-payment bill review, post-payment bill audit, and direct negotiation of over 65 million in billed charges annually.
• Handling appeals, working with vendors, brokers, and payors toward resolution.
• Developed and maintained strong Third Party Administrators, Brokers, and Vendors relationships and educate them about services related to transplant and neonates cases.
• Gather and review clinical and financial information from such as U/R vendors, TPAs, and brokers to determine if a cost containment plan is needed.
• Consult with Case Managers, TPAs, and Brokers on transplant and neonate cases to facilitate successful implementation of cost reduction strategies.
• Organize, secure, and integrate specific objectives and time-specific actions in order to accomplish the objectives of the cost containment plan.
• Gather relevant information on an on-going basis to determine that plan's effectiveness and measure cost benefits and set accurate reserves.
• Assessing severity of on-going claims.
• Adjusting reserves for accuracy.
• Serve as a clinical resources for other Medical Underwriting staff based on clinical specialty in transplants and /or neonates cases.
• Attained 12 million dollars in savings over 3 years for previous Stop Loss Company.

• Coordinates and finalizes patient account audits, pre-screens patient medical records to recoup under-billing, and instructs and consults with hospital management and staff to resolve documentation inadequacies or make improvements in patient chart documentation and charging procedures.
• Reviews medical record for accuracy and completeness, and ensures availability of medical record for hospital pre-audit and insurance company audits.
• Reviews patients medical record, identifies and analyzes diagnoses, procedures, and supplies pertaining to patient's hospital stay, and verifies that appropriate charges are listed on patient's itemized statement. Makes adjustments as necessary using knowledge of nursing procedures and practices.
• Coordinates and analyzes data from multiple computer systems, and assimilates information from various data sources.
• Research late charges, credits, and payment accounts, and acts as liaison between insurance companies and the Business Office for pre-payments of charges.