GWENYTH VENTICINQUE

*** *. ******* ***** ******* Unit 2204 Henderson, NV, 89012 702-***-**** acbu1o@r.postjobfree.com

PROFESSIONAL EXPERIENCE

Inovalon

Remote Field Reviewer April 2013 - June 2013 (Seasonal)

• Accurately and efficiently conduct medical record review for HEDIS measures.

• Schedule on-site visits with provider offices, clinics and other clinical facilities

• Copy or scan relevant components of the medical record to support reviews performed.

• Upload scanned medical data daily.

• Participate in required training.

• Communicate effectively and professionally with provider offices, clinics and other clinical facilities.

• Ability to multitask and troubleshoot problems independently.

• Travel to medical facilities in specified area of region to complete chart reviews.

• Abide by all HIPAA and associated patient confidentiality requirements.

• Maintain consistent reliability ratings of 95%.

Sunrise Hospital

Nurse Auditor February 2002 - September 2012

• Under direction, performed specialized administrative duties pertaining to hospital billing and

reimbursement activities utilizing knowledge of both nursing and administrative practices audited the

charges on medical bills.

• Performed managed care defense audits and under/over charge audits; reviews charge-related patient

grievances; reviews denied charges, recommends appeals and/or facilitates the resolution of root causes

where appropriate.

• Read and understand patient medical records and other treatment documentation; interpret medical

provider notes and comments, including the use of common acronyms and abbreviations.

• Identify discrepancies between medical information and financial charges.

• Interpret and apply laws, rules, regulations and policies related to patient accounting, billing, collections,

and general hospital administration.

• Collect, interpret and evaluate narrative and statistical data pertaining to administrative, fiscal

management and patient matters; prepare complex reports, memoranda and other written materials.

• Utilize standard business equipment, including computer hardware and software. Analyze and resolve

problems and complaints. Computer-based business applications, including word processing and

spreadsheet applications.

• Able to understand and correctly fix/identify ICD-9 codes and all coding terminology.

Sunrise Hospital

Licensed Practical Nurse May 1992 - February 2002

• Administer prescribed medications or start intravenous fluids, noting times and amounts on patients'

charts.

• Observe patients, charting and reporting changes in patients' conditions, such as adverse reactions to

medication or treatment, and taking any necessary action.

• Provide basic patient care or treatments, such as taking temperatures or blood pressures, dressing

wounds, treating bedsores, giving enemas or douches, rubbing with alcohol, massaging, or performing

catheterizations.

• Provide basic patient care or treatments, such as taking temperatures or blood pressures, dressing

wounds, treating bedsores, giving enemas or douches, rubbing with alcohol, massaging, or performing

catheterizations.

• Sterilize equipment and supplies, using germicides, sterilizer, or autoclave.

• Answer patients' calls and determine how to assist them.

• Measure and record patients' vital signs, such as height, weight, temperature, blood pressure, pulse, and

respiration.

• Work as part of a healthcare team to assess patient needs, plan and modify care, and implement

interventions.

• Collect samples, such as blood, urine, or sputum from patients, and perform routine laboratory tests on

samples.

• Prepare patients for examinations, tests, or treatments and explain procedures.

• Assemble and use equipment, such as catheters, tracheotomy tubes, or oxygen suppliers.

• Evaluate nursing intervention outcomes, conferring with other healthcare team members as necessary.

• Record food and fluid intake and output.

• Help patients with bathing, dressing, maintaining personal hygiene, moving in bed, or standing and

walking.

• Apply compresses, ice bags, or hot water bottles.

• Inventory and requisition supplies and instruments.

• Clean rooms and make beds.

• Supervise nurses' aides or assistants.

• Make appointments, keep records, or perform other clerical duties in doctors' offices or clinics.

• Provide medical treatment or personal care to patients in private home settings, such as cooking, keeping

room’s orderly, seeing that patients are comfortable and in good spirits, or instructing family members in

simple nursing tasks.

• Set up equipment and prepare medical treatment rooms.

• Prepare or examine food trays for conformance to prescribed diet.

• Wash and dress bodies of deceased persons.

• Assist in delivery, care, or feeding of infants.

EDUCATION

Basic High School Henderson, NV

• High School Diploma

College of Southern Nevada Henderson, NV

• Licensed Practical Nurse Degree

Additional Skills

• Language Skills: Ability to read, analyze, and interpret documents, reports, technical procedures,

governmental regulations, and correspondence; ability to write routine reports and correspondence; and

ability to present information in one-on-one, small group, and large group situations to management and

staff. Ability to apply proper grammar, spelling, punctuation, and format to typed material. Mathematical

Skills:

• Ability to work with mathematical concepts such as probability and statistical inference; ability to

compute discount, interest, profit, loss, ratios and percent’s; and ability to draw and interpret graphs.

Reasoning Ability: Ability to solve a wide range of practical problems and deal with a variety of concrete

and complex variables; ability to interpret a variety of instructions furnished in written, oral, diagram, or

schedule form; and ability to deal with multiple variables.

• Other: Ability to operate related computer applications (i.e. word processing and spreadsheet

applications), and business equipment including, personal computer, copy machine, fax machine, and

telephone. Well organized with the ability to maintain attention to detail. Good conceptual, organizational,

and problem solving skills. Ability to work independently and as a team member. Ability to apply legal

standards to employment situations.

*References available upon request

Contact this candidate