RN, CPC-A seeking local or remote HIIM position (Nashville, TN area)

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RN with a Master's in Nursing Informatics with a CPC-A seeking a leadership position locally in an HIIM department.

STEPHANIE CLARKE-MAHONEY
REGISTERED NURSE, BSN, MS, CCM, CPC-A
812 COLLIERS BEND ROAD
CHARLOTTE, TENNESSEE, 37036
RNCODERCCM@GMAIL.COM
(615)495-2265

OBJECTIVE
Registered Nurse (RN) and Certified Professional Coder Apprentice with specialty experience in Utilization Management, Case Management, Appeals, Revenue Integrity, Commercial insurance, Medicaid insurance, and Medicare. Possessing leadership and team-building skills now seeking a position with leadership responsibility. Ability to effectively communicate in both verbal and written forms to all members of the healthcare team including the patient. Able to work independently to complete tasks in a timely manner.

Many years of remote working experience including supervision of Appeals nurses. Astute and quick to learn new tasks and adapt to change. Creative out-of-the-box thinker with the understanding of research and evidenced-based practice.

EDUCATION

Nursing, Master’s of Science in Informatics September 2010 – February 2013
Excelsior College, Albany, New York

Nursing, Bachelor’s of Science January 2009 – August 2010
Excelsior College, Albany, New York

EXPERIENCE

Clinical Audit Reviewer December 2014 – Present
CHSPS, Franklin, Tennessee

Working Remote-Transfer from Gateway. Assist with creation of a new division of Clinical Review Audit in the Central Appeals Unit performing audits as it pertains to the CIA. Audit accounts reviewing the medical records for ‘Final Rule’ 2-Midnight Stay elements and validity of medical necessity. Using coding knowledge and Medicare Addendum to exclude IP only procedures. Audit other types of accounts as assigned for medical necessity such as spinal surgeries and PCI.

Revenue Integrity/Nurse Auditor April 2014 – December 2014
Gateway Medical Center/CHSPS, Clarksville, Tennessee

Working Remote-Review accounts for accuracy in billing and coding. Resolve edits on accounts that entail clinical and non-clinical interpretation. Add and delete procedure/HCPCS codes. Work with coders to add and delete diagnosis codes as reflected in the medical records. Use electronic medical records to audit charts for completeness in documentation and charges. Educate departments on billing/charging issues.


Clinical Appeals Specialist June 2012 – April 2014
Parallon Business Performance Group, Nashville, Tennessee

Working Remote- Led Appeals Nurses and monitored day to day activities and productivity of Appeals Nurses. Analyze accounts and determine type of appeal. Extract information from hospital records to support medical necessity for inpatient level of care and outpatient services. Analyze root cause of non-payment and research policies of payers, ICD-9, and CPT coding issues and make suggestions for corrections. Work with revenue integrity, case management, and coding to ensure proper billing and appeals. Maintain productivity and meet time frames per policy. Worked four months as interim Revenue Integrity Manager.

Medical Case Manager September 2011 – June 2012
Blue Cross Blue Shield of TN, Nashville, Tennessee

Telephonic commercial Case Management. Coordinate care for members with catastrophic illnesses and injuries. Assist with discharge planning and community resources. Assist members with benefit utilization and benefit questions. Assist with resolution of claims and billing issues. Perform Utilization Management activities for the purpose of approval/denial of Inpatient Rehab, LTACH, Home Health, Durable Medical Equipment, and Home Infusion.

Utilization Manager January 2011 – September 2011
Amerigroup Corp, Nashville, Tennessee

Obtain information from faxed medical records and compare to Milliman guidelines in order to determine medical necessity. If information not sufficient to meet medical necessity route to medical director for review. After medical review communicate with provider decision. Use Webstrat in order to determine working DRG. Utilized CareAdvance and FACETS systems. Also made referrals through SharePoint for medical and behavioral Case Management.

Catastrophic/Private Duty Case Manager August 2008 – January 2011
Blue Cross Blue Shield of TN, Nashville, Tennessee

Working Remote- Travel to member’s homes and various nursing facilities to ensure safe and effective continuum of care. Assess, plan, collaborate with family and member’s to ensure physical and psychosocial needs are met. Utilized CareAdvance and FACETS applications.

Inpatient Nurse Reviewer October 2006 – August 2008
Memphis Managed Care/Amerigroup Corp, Memphis, Tennessee

Working Remote-Travel onsite to an acute care facility to perform chart reviews and discharge planning. Follow the patient for concurrent reviews using InterQual criteria as a basis to be sure they met medical necessity. If medical necessity was not met conference with in-house medical director was completed. If services were denied, wrote the denial letter from a template provided by TennCare. Worked closely with acute care Social Workers and Case Managers to promote continuum of care in the least costly manner.

Previous Experience
07/05-01/06 LifeCare Center of Bruceton-RN Supervisor
11/04-06/05 River Valley Care Center, Charge/Supervisor RN
02/04-11/04 Putnam Hospital, Staff RN
04/01-02/04 CareCore National, LPN Nurse Reviewer


Skills/Computer
Programs

Access/PowerPoint
Artiva
CareAdvance
CarePlanner
Customer Service
DMS
DWT
FACETS
FrontPage 2003
GIMP
HCA View
HPF
Interqual Criteria
Meditech
MIDAS
Milliman Criteria
MS Office Suite
SharePoint
WebStrat
EvriChart
EPIC
CERNER

Certifications

Certification in Case Management
Certified (CCM)
Professional Coder Apprentice (CPC-A)

Organizations
ANIA-CARING
Sigma Theta Tau-Honor Nursing Society
AAPC
NAMAS
 
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