Teri Kibler
Registered Nurse
Keedysville,MD
Summary
Experienxed and highly capable Registered Nurse with over 30 years of experience. Excellent communication skills. Knowledge of the full revenue cycle with a focus on obtaining maximum reimbursement and minimizing recoupment.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Senior Claims Review Nurse
Cooper University Healthcare
04.2022 - Current
- Use clinical knowledge to assist in maximizing revenue
- Perform clinical review of patient charts to determine if charges were billed appropriately, write appeal letters to payers to maximize reimbursement
- Claims adjustments and coding.
Telephonic Case Manager
UnitedHealth Group
06.2015 - 03.2022
- Coordinated care and resources for over 130 Medicare/Medicaid members who are high risk for utilization of services including hospital readmissions
- Helped members to navigate the complex health care system, with education and care plan consultations appropriate to their disease process
- Supported members' wellness, stability and appropriate use of outpatient care network, including coordinating care, access to durable medical equipment and community resources.
Clinical Claims Review Nurse
United Health Care
06.2016 - 03.2021
- Review post service claims for readmissions while adhering to state and federal regulations
- Team lead for rapidly growing Medicaid project for pre and post service claims
- Present complicated cases to medical directors as needed
- Serve as resource to educate co-workers on new state guidelines and procedures.
Nurse Consultant
GPS Healthcare Consulting
04.2014 - 12.2015
- Performed onsite financial risk audits in skilled nursing facilities and hospitals across the United States utilizing Federal, State and CMS guidelines
- Developed recommendations and solutions to resolve audit disputes which resulted in incomplete audits
- Knowledge of billing and coding, medicare and medicaid including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD 9 diagnoses and procedure codes
- Educated providers on how to meet the requirements for state and federal licensing
- Reviewed clinical information for medical necessity and appropriate level-of-care utilizing Interqual evidence based tool for patients admitted to the hospital, rehab or Skilled nursing facility.
Health Services Director/Delegating Nurse
Brightview Assisted Living
10.2011 - 05.2014
- Designed, updated and ensured proper implementation of a comprehensive care plan for more than 100 residents in accordance with all state and local regulations
- Set staffing standards and guidelines to meet service standards and to remain in compliance with any/all regulatory requirements.
Education
Associate in Nursing -
CCBC
Baltimore, MD12.2007
Diploma in Nursing -
Eastern Vocational Technical HS
Baltimore, MD01.1993
Skills
- RN
- Utilization Review
- Oncology
- Medical Surgical
- Case Manager
- MDS Coordinator
- Claims Review
- Nursing
- Nurse Management
- ICD-10
- CPT Coding
- ICD-9
- Documentation Review
- Medication Administration
- Epic
- MDS
- Medical coding
- Documentation review
- Hospital experience
- Supervising experience
- Typing
- Analysis skills
- Patient care
- Acute care
- Clinical documentation improvement
Certification
- Compact State Nurse License
- RN License
- CPR Certification
- Certified Professional Coder
Timeline
Senior Claims Review Nurse
Cooper University Healthcare
04.2022 - Current
Clinical Claims Review Nurse
United Health Care
06.2016 - 03.2021
Telephonic Case Manager
UnitedHealth Group
06.2015 - 03.2022
Nurse Consultant
GPS Healthcare Consulting
04.2014 - 12.2015
Health Services Director/Delegating Nurse
Brightview Assisted Living
10.2011 - 05.2014
Associate in Nursing -
CCBC
Diploma in Nursing -
Eastern Vocational Technical HS
Similar Profiles
Sarah M HowardSarah M Howard
Phlebotomy Supervisor at Cooper University HealthcarePhlebotomy Supervisor at Cooper University Healthcare
Morgan FlorczakMorgan Florczak
Urgent Care Technician at Cooper University HealthcareUrgent Care Technician at Cooper University Healthcare
Joseph JunodJoseph Junod
MICP at Cooper University HealthcareMICP at Cooper University Healthcare
Ahja DunlapAhja Dunlap
Lead Supply Technician at Cooper University HealthcareLead Supply Technician at Cooper University Healthcare
Dargen BladenDargen Bladen
Sales Associate at SheetzSales Associate at Sheetz