Registered Nurse Manager

Karen Kaye McFarland

*** ***** *** **** ********, TX 76028 817-***-**** **************@*********.***

Summary: Self-motivated health care professional seeking leadership opportunity utilizing extensive subject matter expertise, team building experience and process improvement skills

Qualification Highlights:

-Experienced Trainer and Leader

-Process Improvement Track Record

-Communication and Relationship Skills

-Critical Decision Making Ability

-Thorough and Analytical Approach

-Extensive Subject Matter Expertise

Education: Bachelor of Science May 1978 University of Texas at Arlington Nursing Degree

Key Professional Experience:

nThrive/Adreima Corporation (Formerly NHRI) – Revenue Integrity (Phoenix, AZ – 04/07 to Present)

Clinical Nurse Auditor

-Perform and deliver accurate and consistent charge audits via comparison of billing and medical records for 3rd party payers and Medicaid with resolution of clinically related billing errors for timely claims submission and payment

-Reported directly to the Compliance Manager and/or the VP of Revenue Integrity

-Collaborate with cross-functional teams such as clinical departments, patient financial services and compliance manager

-Served as clinical liaison between healthcare providers and billing department for any additional documentation needed to support charges

-Performed charge audits by reviewing medical documentation in the EMR

-Identify and report trends in clinical billing errors with recommendations for improvement

-Summarized educational opportunities for healthcare providers based on audits

-Reviewed charge description master (CDM) on a regular basis

-Assisted and encouraged colleagues with complex audit challenges

-As Team Lead, reviewed and assisted team with complex scenarios as necessary

-Served as trainer on charge correction procedures and policies

-Advised other auditors based on account subject matter expertise and best practices

-Performed computer conversion audits as assigned in several different hospitals

-Established new revenue streams via previously untapped areas such as lactation education and pharmaceutical overcharges for immune-compromised patients

-Integrated process improvements into charge error workflow to ensure adoption and satisfaction

-Performed QA on audited accounts for improvement in outcomes

-Performed any other duties assigned within a timely manner

-Worked in the hospital setting for the first 4 to 5 years, then moved to remote setting home based with 11 years’ experience to date in this role

-Citrix/Valco/MediTech/MS Word proficient

-HIPPA Certified

Concorde Career Institute – VN Program: Clinical Instructor Level III (Arlington, TX – 03/06 to 04/07)

-Responsibly managed LVN students in the level 3 clinical setting, advancing 100%

-Mentored clinical instructors and received excellent evaluations for communication skills

Legal Nurse Consulting – Professional Legal Nurse Consulting: Owner (Burleson, TX – 03/00 to 02/08); Watson & Parker: Consultant (FW, TX – 01/98 to 03/00); Law Firm of Darrell Keith (FW, TX – 07/96 to 12/97)

-Built successful business by increasing clientele over 50% each of first five years via word of mouth

-Collaborated with clients to ensure strong deposition strategy and execution based on claims merit

Saint Joseph Hospital – Utilization Management Department: Pre-Admission Coordinator / Utilization Coordinator (FW, TX 1992 to 1996)

-Ensured appropriate DRG selection based on patient records and healthcare plan coverage

-Engaged hospital leaders and clinicians to revamp transfer process and went on to establish the first transfer coordinator position

-Assisted with QA in areas such as transfers, infectious disease and adverse drug reactions

-Developed and led pre-operative teaching program

Registered Nurse Roles – Various departmental roles from 1978 through 1991 spanning clinical, teaching and leadership responsibilities including but not limited to PACU, Ambulatory Care, Emergency Department, MICU, SICU and Medical Surgical areas. Mastering IV skills, IV Hydration, IV Medications, IM Medications, PO Medications, ABG’s, Labs, EKG’s, BLS/ACLS certification, Trach care, Volume Ventilators, Hemovacs, Jackson Pratt drains, changing surgical dressings, Wound care as needed, clinical documentation of all care, develop good rapport with all teammates, physicians, PT/OT/ST/RT and administration.

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