Courtney M. Singleton LPN

***** ****** ******* ****

Jacksonville, FL. 32218

904-***-**** (cell)

ac0ocs@r.postjobfree.com

Job Related Skills

● Medical Review Nurse

● CMS Guidelines

● Three year’s experience with HEDIS Project

● Medical Audit

● Utilization Review

● Prior Authorization Nurse

● 701B Certification

● Quality Improvement

● Nurse Reviewer meetings

● Quality Reviews

● Medical Case Manager

● Medical Claim Processor

● Data Entry

● Inbound Customer Service with Providers

● Icd9-10 coding, CPT codes, and HCPC codes

● Microsoft Word

● Excel Spreadsheets

● Milliman/InterQual

● Observe patients, charting and reporting changes in patient conditions

● Administer prescribe medications

● Collect specimens

● Tube feedings

● IVs

● Injections (vaccinations, PPD, etc.)

● Wound Care

● Supervise and select Nurse Aid assignments

Work Experience

Florida Blue (Contractor for HEDIS Project) Jan. 2016 – March 29, 2017/ February 2014 - May 2014

● Researching and abstracting Medicare claim information from medical records to convert members to be compliant for HEDIS measurements.

● Contact different provider offices for needed medical records to be sent over via mail/fax

● Contact member with important information regarding their exams needed for the year

● Letters generated and sent to providers for medical records

● Kept track of all members medical information via Excel spreadsheet

River Region Health Services (PRN) August 2015 – Jan. 2016

● Observe and administer prescribed methadone to patients

● Counseled each patient about their doses

● Kept track of all medication

● Monthly assessments on patients

● Document each dosage given to patient

● Chart patient’s daily doses in medical record

● Dose pregnant females on prescription methadone at Duval County Jail

Novitas- Solutions (Medical Review Nurse September 2014 – April 2015

● Review of medical records from physician offices and home health records submitted by Ambulance companies for prior authorization

● Knowledge of CMS guidelines

● Making an affirmed or non-affirmed decision based on records received

● Entering decision in system database and generating decision letter to send to supplier

● Quality checking nurse decisions that come back for review

● Participating in biweekly meetings with medical director to discuss findings

Mental Health Resource Center (Medical Case Manager) August 2012 – Jan. 2014

● Scheduled appointments for client and accompanied the clients to their appointments with the Nurse Practitioner

● Utilization reviews for inpatient clients

● Completed monthly assessments on each client

● Assisted clients with taking and staying stable on their Psychotropic medications

● Administered biweekly and monthly injections to clients

● Kept track of all clients charts and updated charts with all medical information

Shands Jacksonville (PRN) August 2012 – May 2013

● Observed patients on transitional care unit and charted patient’s findings

● Administered around the clock prescribed medications

● IV therapy treatment completed on patients on antibiotics

● Tube feedings

● Wound care

● Completed plan of care for each patient

Jacksonville Metro Treatment Clinic August 2011 – Feb. 2013

● Observe and administer prescribed methadone to patients

● Counseled each patient about their doses

● Kept track of all medication

● Monthly assessments on patients

● Document each dosage given to patient

Blue Cross Blue Shield of FL June 2002 - May 2010

● Data Entry Clerk (PEB Student)

● Blue card inbound customer service rep from providers correcting medical claims in DIAMOND system or sending claims to adjustment department

● Blue card Written team project

● Medical and Dental claim examiner processing claims for providers and members through DIAMOND system

● Teleworker working from home processing medical and dental claims

● Knowledge of ICD9, HCPCS, and CPT codes

● Knowledge of CMCA, DIAMOND, PIP, AND IMS systems

Education

Jersey College

Jacksonville, FL.

LPN to RN Bridge Program – Pending

Keiser Career College

Jacksonville, FL.

Practical Nursing Program - May 2011

Andrew Jackson High School

Jacksonville, FL.

High School Awarded - May 2004

Certifications

30 Hour IV Certification

BLS certification

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