Esther M. Roberts, RN, CPC

Hayward, CA ***** 510-***-**** ac59x0@r.postjobfree.com LinkedIn

Medical Review Nurse

Methodical and detail-oriented healthcare professional with experience accurately abstracting, coding, and reviewing medical records to ensure accuracy and compliance. Diverse background in clinical nursing, encompassing Critical Care, Cardiac Rehabilitation, and Critical Care Transport, paired with quality assurance experience creating thorough and strategic coding abilities. Certified CPC proficient in ICD 9, ICD 10, CPT and HCPCS.

AREAS OF EXPERTISE

Medical Records Review

HIPPA Compliance

Medical Terminology

Electronic Medical Records

Abstracting & Coding

HIX, HEDIS, CRG, CARA

Documentation Compliance

Background of Critical Care

Quality Assurance

ICD 9 & ICD 10

Research & Analytics

Background of Cardiac Rehabilitation

PROFESSIONAL EXPERIENCE

HEDIS RN PSN (Professional Services Network, Inc.), Silver Springs, MD 2018

Completed a contract project for HEDIS 2018 (Healthcare Effectiveness Data and Information Set) performing comprehensive reviews for the Community Health Plan of Washington. (Remote)

SITE REVIEW CONSULTANT Inovalon (formerly Medassurant), Bowie, MD 2009-2016

Accurately completed on-site and remote chart reviews; abstracted and analyzed clinical data, ICD 9, and ICD 10 codes from medical records participating in HCC projects.

Demonstrated expertise in HCC reviews, experience with Healthcare Effectiveness Data and Information Set (HEDIS) projects and CRG reviews.

Acquired and applied extensive knowledge of current coding guidelines safeguarding compliance.

Precisely reported patient risk profiles ensuring appropriate reimbursement.

Established and maintained collaborative intradepartmental relationships fostering the timely completion of deadline driven projects.

RESEARCH ASSISTANT University of California, San Francisco, CA 2008

Investigated potential screening tools for use in ICU patients experiencing Delirium.

Assessed and facilitated early identification tools of delirium and its underlying causes in patients admitted to intensive care units.

Evaluated symptom severity; determined relevant tools, treatments, and techniques to resolve delirium and promote health and recovery.

SITE REVIEW CONSULTANT Medassurant, Bowie, MD 2007-2008

Systematically studied and extracted diagnostic and therapeutic data from medical records safeguarding accuracy.

Performed remote medical records reviews and data abstraction compiling actionable data and information for corporate analytics.

Completed HIX and CARA project reviews evaluating ICD 9 coding and monitoring reimbursement accuracy.

Evaluated provider documentation in quality parameters for HEDIS reviews.

CRITICAL CARE TRANSPORT RN American Medical Response, San Jose, CA 2002-2006

Performed comprehensive care of critically ill patients during intra-facility transports.

Monitored and treated patients addressing and averting worsening clinical conditions using high tech equipment such as ventilators and infusion pumps for delivery of vasoactive and other drugs as indicated.

Managed the needs of adult, pediatric and high-risk obstetric patients enhancing their stability for target destination.

Provided emergent transport to critically ill stroke (Cerebrovascular Accident) and Myocardial Infarction patients requiring a higher level of definitive care. These transports also included a wide range of patients with diverse clinical conditions.

Additional experience as a Medical Advice and Cardiovascular Intensive Care RN with various hospitals and medical centers.

EDUCATION & CREDENTIALS

Master Degree of Science in Nursing, Concentration: Critical Care and Trauma University of California, San Francisco, CA

Bachelor Degree of Science in Nursing Oklahoma Baptist University, Shawnee, OK

Registered Nurse – California

Public Health Nurse

Certified Professional Coder

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