Remote Medical Records Review & Audit Nurse

Career Summary

Medical Records Review & Audit Remote Nurse for 20 years. Strong clinical skills with pediatric, adult, & geriatric clients in a wide array of healthcare settings. Received intensive training from Data Analyst to assure accurate review & audit of medical records.

Professional Profile

Accomplished Remote Nurse with attention to details in Medical Records Abstraction and Chart Review. Member of Medical Abstraction Nurse Team reviewing & auditing high volumes of medical records for hospital and multiple MD offices & clinics utilizing 15 different measures per ACO Guidelines.

Communicates with MD and/or facility personel to clarify documentation or required missing documentation to ensure accurate chart audit.Knowledge of Medical Billing, Coding-ICD-10-CM,& CPT .Knowledge of MCG & Interqual CareGuidelines.

Currently working as a Telehealth Remote Bilingual Liason Nurse. Fluent in English, Spanish, and Portuguese

Expertise in auditing high volumes of Medical Records for accuracy.Detail-oriented, strong decision-maker, team player and good communicator via phone, IM, & email, while working closely with physicians, patients, and insurance company personnel & maintaining HIPPA Compliance.

Certification

Hedis Certification - *Completed Intensive training on Hybrid & IRR measures- August, 2018

VAD Training Certification- June,2016, TESOL Certification- November, 2008

Intraveneous Therarpy (IV) Certification - June 21, 2000,

( ACLS) Advance Cardiac Life Cardiovascular Certification January, 2000

Education

Licensed Practical Nurse, 1998 (LPN in 5 states : MS, NY, FL, GA, NJ)

Hinds Community College, Vicksburg, MS -LPN (1997-1998)

PearBlossom Private School – High School Diploma received in 1997

Professional Experience

February 2018- Present, VRI Telehealth Remote Bilingual Liason Nurse

Perform telephone triage on 15-20 clients per hr.incuding post triage & F/U care. Entering documentation with appropriate codes for insurance company and team members to view.

Communicate with physician or facility personel the status of clients as needed via telephone or electronic fax accompanied by detailed electronic documentation.

December 2017 – JFK Hospital Medical Abstraction Nurse for ACO Guidelines & Criteria, Edison NJ

Chart abstraction & Audit for Multiple Dr.’s offices,clinics,& JFK Hospial using EMR and/or medical chart. Communication with Physician and facility personel including clarification of medical records to complete accurate abstraction & audit per ACO guidelines for 2017.

August 2012 – to present, Pediatric Nurse, Bayada Home Health Care, Atlanta, GA & Union, NJ

Documentation and careful review of Medical Records for assigned clients in accordance with Hippa regulations

Provide nursing services to medicaly fragile infants that increased their ability to respond to others and thrive in their home environments including caring for infants and pediatric clients with tracheostomy and ventilators.

March 2011 – August 2012, Field Nurse, Cobb County Schools, Marietta, GA

Computerized Documentation and Maintained Medical Records for over 600 students

Provide nursing care to suspected communicable illnesses that helps prevent transmission to others through exclusion and education.

April 2010 – March 2011, Pediatric Nurse, Maxim Health Care, Hialeah, FL & Atlanta, GA.

Provided services that included: medication administration, administration of nebulizer treatment, complicated care in various settings,apnea monitoring, ng tube feedings, & GJ-tube feedings.

Documentation and extensive attention to Medical Records.

January 2009 – December 2009, Medication Infirmary Nurse, SCO Family of Services Medication, Long Island, NY

Documentation of all procedures and observations. Auditing Medical Records every shift for accuracy. Provided dependable nursing services for mentally and physically handicapped children.

November 2000 – November 2009, Private Duty Nurse, Non-Profit Religious Organization

Provided comprehensive private duty nursing care for patient suffering from Parkinson’s, Alzheimer’s,Multiple Sclerosis, dementia, diabetes, & paralysis that improved the quality of life for the patient.Verbal and electronic report & documentation done.

August 1998 – September 2000, Geriatric Nursing, Heritage House Nursing & Retirement Center

Provided charge nurse duties for over 30 patients and 4 Certified Nursing Assistants. Documentation & 24hr. review of Medical Records.

Awards

Outstanding Student in Practical Nursing Deans Scholar Graduated 3rd place in Practical Nursing Class Perfect Attendance in Practical Nursing Class,Hero Award 2016 Bayada Health Care for Outstanding Nursing Care

REFERENCES AVAILABLE UPON REQUESTS

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