Taunisha Draudt, RN

As a Registered Nurse with over 27 years of experience, I have developed a strong background in medical claims review and auditing. I am currently a Revenue Auditor at Northside Hospital, coordinating and finalizing patient account audits, pre-screening patient medical records to recoup under-billings, and instructing and consulting with hospital management and staff to resolve documentation inadequacies or make improvements in patient chart documentation and charging procedures. In addition, I have attained extensive knowledge in Stop Loss Medical Insurance as a Specialty Claims Nurse, with a focus on cost containment of catastrophic medical claims, resulting in $12 million in savings over 3 years. I have worked in various healthcare settings, including Neonatal Intensive Care, Medical/Surgical and Transplant departments, where I honed my skills in patient care and medical documentation. I strive to maintain a positive attitude and commitment to continuous learning and growth.

• 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 resource for other Medical Underwriting staff based on clinical specialty in transplants and /or neonates cases.

• 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.
• Maintains the Hospital's Observation log on an ongoing basis.
• Conducts in-service training with staff in patient care and ancillary departments in order to point out recurring documentation inaquacies and to suggest corrective measures.

Registered Nurse

Georgia Board of Nursing

Issued May 2008 · Expires Jan 2027

Credential ID RN196784

Registered Nurse

New York State Board of Nursing

Issued Sep 2007 · Expired August 2010

Credential ID 592105

Licensed Practical Nurse

New York Board of Nursing

Issued Jan 1998 · Expired Sep 2007

Credential ID 254615