Tina Myers

Medical record review of denied claims, submitted appeals to insurance companies. Review of medical record to obtain approval from insurance company. Worked with insurance verification to obtain authorization for patient services and hospital days. Documented in specific software systems.

Responsible for Medicare recovery auditor administrative law judge hearings. Arranged and participated in administrative law judge hearings with physicians and attorneys. Submitted appeals to Medicare and other insurance companies. Followed and documented in revenue cycle software program.

Responsible for reviewing and appealing denied claims, assist with concurrent and retro review in all areas of hospital on inpatient, outpatient and observation patients. Developed process for managing surgical patients coming into hospital on daily basis. Training new employees hired into case management department. Assisted with discharge planning as well as Blue Cross utilization review of hospitalized patients.

Concurrent and retro review of medical record using interqual criteria throughout hospital. Working closely with physicians, patients and family members regarding discharge needs, arranging home health, durable medical equipment as well as skilled and long term placement.

Responsible for arranging patient appointments, management of accounts payable and receivables, employee payroll, billing claims and managing taxes. Performed daily management of business. Co- owner of business.

Review of admission and daily staff paperwork, chart audits, preparation of daily field nurse schedule and functioned as field nurse providing care of patients in home when needed.

Performed as physician based case manager. Utilization review using interqual criteria for high admitting physician, initial assessment of patients to determine discharge needs. Worked closely with discharge planners, nurse practitioners and office staff.

Responsible for educating newlyn enrolled members, performing initial exercise test and monitoring of patients during exercise session. Arranging home oxygen and other pulmonary equipment for patients in hospital setting.

Case managed patients in home setting, provided care consisting of education, wound care, intravenous medication administration, phlebotomy as well as general assessment.

Staff nurse in sub surgical and trauma intensive care units. Providing care to critically ill and injured. Functioned as charge nurse.