Ernestine Evans-Nash

**** ********** **** *****, **************, VA 23111

Email: addz6f@r.postjobfree.com; Cell Phone # 443-***-**** Resourceful & Detail-Oriented Registered Nurse with extensive experience in in both patient care and administrative positions

Audits, Regulatory Compliance, Record’s Review, Patient Screening, Healthcare Work flow Analysis & Transformation Health systems

Summary of Qualifications

Master Nursing Degree, Informatics

Bachelor of Science Degree In Nursing and Business Administration with a current Registered Nurse License In Virginia and Maryland

Long history of quality and regulatory compliance assurance in addition to proactive in supervision and training of LPN’s and other medical staff Proficient in performance of audits and reviews in addition to compilation of reports and directions panel reviews

Proven record of revenue recovery through effective auditing of health information billing procedures and records in addition to improving documentation processes

Professional Experience

Nurse Analyst

Bon Secours Mercy Health System

Richmond, Virginia

November 2013- May 2020

-Performed audits on government and non government accounts to achieve clean claims which assist in decrease denial charges. This was performed by thorough review patients clinical documentation to determine the validity of the denial and/ or or identify any charges, CPT/HCPCS coding discrepancies; documents audit findings; post debits and credits to accounts. In addition, this enhanced clinical practice documentation and increase efficiency within billing Revenue Cycle. This also, facilitated enhancement in Customer Service satisfaction with accurate procedural services to patient accounts.

-Collaborate with other Departments such as Pharmacy, Nursing Units, OR, Wound Care, Oncology, Gastrointestinal Endoscopy, Labor Delivery, and Cardiology Department to report fair and accurate clinical documentation. Maintain a positive working relationship while researching and investigating issues; prepare excellent written or oral responses as needed.

-Developed and taught Excel and Microsoft to staff track-work productivity and Department Monitoring Detail Accounts Receive Report known as DTAR.

-Maintained positive customer relations; research and investigate issues; written or oral responses as needed.

-Communicate clearly and concisely, both orally and in writing; effectively present information to groups and individuals.

-Establish and maintain cooperative working relationships with others including nurse, administrations, managers, and other health care industry personnel.

-Provide excellent public relations and courteous customer service.

-General familiarity with medical record coding systems, ICD9, DRG, and CPT coding. Nurse Specialist I

-Department of Juvenile Justice

Medical Department, State of Maryland

May 2010- October 2013

-Triage and treat youth at sick call and emergencies

-Administer medications and immunizations

-Created electronic health data formate in IMMUNET for tracking youths’ Immunization

-Taught LPN’s and RN’s how enter youths’ electronic health and immunization information

-Collaborated with educational and legal professionals regarding youths’ medical diagnosis and treatment

Nurse Reviewer II

Department of Health & Mental Hygiene

Office of the Inspector General, State of Maryland ; Baltimore MD

-Worked close with Law Enforcement; Provide consultations and recommendations in cases for possible abuse or misuse by providers for cases referred by the Inspector General’s Office

-Apply and utilize CMS federal and Maryland State regulations while auditing medical cases by providers.

-Obtain on site medical records, prescriptions and documentation such as time keeping records and procedural service charge from providers. Maintained and worked within the scope of HIPPA Guidelines and CMS Regulations when reviewing patients’ medical information.

-Developed Excel spread sheet for monitoring and tracking Providers and Facilities errors to communicate onto to Management, OIG Director and Legal Team.

-Performed various audits and exit interviews with third-party auditors and coordinate audit review with Maryland State Legal team and accounts.

-Save Revenue by reversing overpayments discovered this through use of extensive use of Nursing process and Maryland Medicaid regulation and policy’s while collaborating with other OIG Team members from varies departments such as Department of Aging, Pharmaceutical Department, Medical Equipment and supplies.

Nurse Auditor

Sentara-Obici Hospital

Suffolk, VA.

May 1997- May 2005

150-bed facility providing residents of Suffolk and Western Tidewater with range of inpatient and outpatient care and treatment services

-Reviewed charges on a sampling of outpatient and in-patient accounts to assure accurate billing information in comparison with medical record documentation. Ensure state and federal guide lines where met through accurate CPT, HCPCS and ICD coding base on patients’ clinical documentation.

-Performed defense audits and conducted exist interviews switch third-party auditors and directed review sessions with department directors to correct problems revealed in audits

-Collaborated and coordinate with insurance representatives to resolve billing questions and claims forms accuracy issues and consult with billing office manager and staff for questions relating to clinical aspects of care

-Discovered and reclaimed millions of dollars in ER revenue lost to technical information programming errors occurring when billing coding did not transfer to patients’ billing statements

-Increase revenue capture of Physical Therapy Department of Medicare patients by implementing CMS 30 day re-evaluation guideline to be conducted by patients physical therapist.

-Improved insurance payment receipts by challenging insurance denials with supporting medical documentation

Additional Experience

-United States Navy Nurse, Portsmouth Naval Medical Center, John Paul Medical Center Education

Master science Degree Nursing Informatics

Walden University 2012, Minneapolis, MN

Education

Bachelor of Science Degree/ Nursing

University of Charleston 1990, Charleston, WV

Bachelor of Science Degree/Business Administration West Virginia State College, 1985, Institute, WV

License

-Registered Nurse, Virginia and Maryland

Additional Skills

-Proficient in Microsoft Office Suite (Word, Excel), Excellent in Power Point Presentation, Meditech Hospital Billing, Epic System, N-Thrive Billing, Maryland Information System (MMIS) Possess Leadership skills to facilitate a multidisciplinary approach promote quality care Qualifications

-Excellent computer skills

-Hardworking, independent and reliable

-Able to grow with company through versatility and adaptability

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