Teresa Crosby
Columbia,TN
Summary
Knowledgeable Licensed Practical Nurse with strong background in clinical documentation and utilization management. Demonstrated success in ensuring accurate and compliant medical records, enhancing patient care through meticulous documentation practices. Consistently applied critical thinking and attention to detail in collaborative environments.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Clinical Documentation Specialist
Vanderbilt University Medical Center
05.2011 - Current
- Communicated with physicians, nurses and other caregivers to explain importance of accurate and clear documentation.
- Maintained strong knowledge of medical terminology, diseases and conditions and procedures.
- Served as a resource for healthcare professionals seeking guidance on various aspects of clinical documentation, fostering effective communication among team members.
- Reduced risk exposure by promptly addressing any identified discrepancies or inconsistencies within patient records.
- Ensured compliance with regulatory standards and guidelines through meticulous attention to detail in completing clinical documentation tasks.
- Analyzed data from audits to identify areas for improvement in clinical documentation processes, implementing targeted interventions for positive change.
- Expedited accurate clinical documentation completion by promptly responding to queries from healthcare providers and support staff, offering timely guidance and support.
- Carefully reviewed patient files for clarity on diseases, diagnoses and procedures to determine quality of care.
- Verified medical terminology and codes to deliver accurate and up-to-date information.
- Improved clinical documentation quality by conducting thorough reviews and providing feedback to healthcare providers.
- Used medical center hardware and software to produce required reports.
- Learned and adapted quickly to new technology and software applications.
Utilization Review Nurse
Vanderbilt University Medical Center
05.2006 - 05.2011
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Optimized hospital stays by monitoring admissions for appropriateness based on established clinical guidelines while considering each patient''s unique circumstances.
- Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
- Streamlined the case management process by effectively prioritizing high-risk cases for timely intervention and followup.
- Performed admission reviews for medical necessity based upon Interqual & VUMC based Guidelines.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Collaborated with insurance companies to verify coverage, clarify benefits, and facilitate authorization for medical services, reducing delays in patient care delivery.
- Demonstrated commitment to ethical practice by upholding patient confidentiality and advocating for individual rights in all interactions with stakeholders.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Precertification Specialist
Med Solution Group
06.2003 - 05.2006
- Conducted thorough review of patient medical records for authorization of outpatient imaging, based upon insurance provider guidelines, ensuring timely authorization to physicians and imaging centers for approved services.
- Assisted with new hire training on software programs and tools utilized in the precertification process.
- Elevated patient satisfaction by offering compassionate guidance and support during the often-stressful precertification process.
- Enhanced interdepartmental collaboration through effective communication with case managers, physicians, and medical directors.
- Reduced patient wait times for approval by diligently reviewing medical records and obtaining necessary documentation.
- Maintained strict adherence to HIPAA regulations by safeguarding confidential patient information during all aspects of the precertification process.
Precertification Specialist
Cigna
01.2000 - 06.2003
- Reduced patient wait times for approval by diligently reviewing medical records and obtaining necessary documentation.
- Expedited treatment commencement by promptly acquiring authorizations for medically necessary services within required timeframes.
- Resolved discrepancies with client applications to verify eligibility.
- Ensured smooth communication between healthcare providers, patients, and insurance companies, resulting in timely approvals and positive experiences.
- Reduced errors in eligibility determinations by maintaining thorough knowledge of program guidelines and regulations.
- Communicated with people from various cultures and backgrounds on the review process.
- Continuously expanded personal knowledge of industry regulations and updates through ongoing professional development, ensuring accurate and up-to-date expertise in the precertification process.
- Developed comprehensive knowledge of various insurance plans, policies, and coverage limitations to provide accurate guidance to patients and providers.
Education
Licensed Practical Nurse - General Studies
Maury Regional Hospital School of Nursing
Columbia, TN01-1976
Skills
- Documentation compliance
- Exemplary communication skills
- Training and mentoring
- Medical terminology
- Healthcare staff interaction
- Strong attention to detail
- HIPAA regulations
- Regulatory compliance
- Healthcare coding
- EMR / EHR
Certification
Licensed Practical Nurse
State of Tennessee Department of Health
Board of Nursing
Timeline
Clinical Documentation Specialist
Vanderbilt University Medical Center
05.2011 - Current
Utilization Review Nurse
Vanderbilt University Medical Center
05.2006 - 05.2011
Precertification Specialist
Med Solution Group
06.2003 - 05.2006
Precertification Specialist
Cigna
01.2000 - 06.2003
Licensed Practical Nurse
State of Tennessee Department of Health
Board of Nursing
Licensed Practical Nurse - General Studies
Maury Regional Hospital School of Nursing
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