Registered Nurse Medical

Jennifer Cortez

Email: ********@*************.***

Address:

City: Sherman

State: TX

Zip: 75090

Country: USA

Phone: 903-***-****

Skill Level: Any

Salary Range:

Primary Skills/Experience:

Registered nurse with four years experience in the medical review setting. Adept at interpreting regulatory guidelines and applying them to clinical records to determine if provider is billing and coding accurately. Team player, yet also very self-motivated. Able to work well with minimal supervision.

Educational Background:

High School Dipolma from Grayson County College, Denison TX 1/2001 to 6/2001 (Nursing)

Job History / Details:

Professional Summary

Registered nurse with four years experience in the medical review setting. Adept at interpreting regulatory guidelines and applying them to clinical records to determine if provider is billing and coding accurately. Team player, yet also very self-motivated. Able to work well with minimal supervision.

Licenses

Registered nurse - license number 680801 - expires 4/30/2013

Skill Highlights

Utilizes sound clinical judgement when reviewing medical records.

Able to visualize patients based on the written word.

Experienced in utilizing government and local policy to make determinations.

Accustomed to working individual claims, limited or widespread probe reviews, and statistical random sample reviews.

Skilled at making referrals to the Zone Program Integrity Contractor for providers with high error rates or evidence of potential fraudulent behavior.

Facilitated provider education meetings upon completion of probe reviews.

Able to impart critical information without creating a threatening environment.

Proficient in computer programs such as Excel, Word, PowerPoint, electronic medical records system and claims processing system.

Participated in Webinars to educate provider community on a predetermined service.

Mentored new employees in claims adjudication and contractor guidelines.

Professional Experience

September 2008 to Current

TrailBlazer Health Enterprises Denison, Texas

Medical Reviewer III

Using government or local policy, reviews documentation to determine medical necessity and appropriateness for coverage and reimbursement. Documents medical rationale to justify payment or denial of services. Communicates with providers regarding billing and documentation errors or deficiencies.

March 2002 to Current

Texas Health Presbyterian/WNJ Sherman, Texas

Staff nurse (PRN) - Medical/Surgical and Postpartum

Cares for patients with a wide range of illnesses/surgeries in a safe and efficient manner. Performs head to toe assessments and uses critical thinking skills to intervene as needed. Communicates any abnormal findings to the doctor and carries out orders in a timely manner.

June 2001 to March 2002

Texoma Medical Center Denison, Texas

Staff nurse - Critical Care Unit

Provided care to patients with acute cardiovascular problems such as chest pain or shortness of breath. Cared for post-heart catheterization patients and operated as a step down unit for post-CABG patients. Monitored hemodynamic and telemetry status of patients and intervened as necessary.

Education and Training

2001 Grayson County College Denison, Texas

Associate of Applied Science Nursing

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