Registered Nurse Medical
Resume:
HYACINTH PADUA, BSN, RN
Albuquerque, NM 87123
Profile/Objective
To obtain a position that involves medical chart review, coding, or
auditing.
Licensure and Certificates
?Registered Nurse, license R61445, issued by the NM Board of Nursing.
Valid until June 2015.
?Previous certification for outpatient medical coding from the American
Academy of Professional Coding.
?Bachelor of Science in Nursing: (May 2007) The University of New Mexico,
Albuquerque, NM. Cumulative GPA: 3.7
?Bachelor of Arts in Psychology: (December 2004) The University of New
Mexico, Albuquerque, NM. Cumulative GPA: 3.8. Minor in Criminology. Golden
Key International Honor Society.
Professional Experience
Utilization Review Nurse
(Jan 2012-present)
Health Data Insights
?Full time. Reviews various cases, usually emergency room or urgent care
admissions, then determines if these qualify as inpatient versus outpatient
care. Reviews charts for the Medicare Recovery Audit Contract in order to
identify under- and overpayments to medical providers and/or healthcare
facilities. Applies strict critical thinking skills using knowledge in
clinical nursing and the Medicare's CMS guidelines in order to make
accurate decisions by examining the severity of symptoms and treatments,
then reporting these information in an organized, easily understandable
manner. Uses the Milliman Care Guidelines and Interqual as resources for
making accurate decisions. Maintains an accuracy of 94% on average. Attends
regular meetings and trainings to keep up with current knowledge and
policies.
RN Site Review Consultant (March
2010-Jan 2012) MedAssurant. Bowie, MD.
?Full time, project based. Traveled to local healthcare facilities to
perform scanning and data abstraction for HEDIS and Claims Integrity
reviews to maximize healthcare revenues. Proficient with E/M coding
guidelines, identification of misused codes, and DME medical necessity
reviews. Performed detail examination of the symptoms, medical history,
exam, and treatment, then assigned the appropriate E/M codes that reflect
the severity of symptoms and treatments. Maintained excellent accuracy
scores and a positive working relationship with the local facilities.
RN Clinical Auditor
(May 2010-Nov 2010)
Outcomes Health Information Solutions.
?Full time. Audited inpatient, ambulatory, and physician office charts for
Medicare risk adjustment to optimize healthcare revenues. Thoroughly
reviewed every chart to ensure that important diagnoses codes were not
overlooked. Proficient in ICD-9, CPT, and HCPCS coding. Proficient in
abstracting and capturing HCC codes. Maintained excellent accuracy scores
and time management skills to meet deadlines.
RN Home Health (Sept 2009-Mar
2010)
Professional Case Management. Albuquerque, NM.
?Part time. Assisted clients with daily living activities such as personal
hygiene and household chores as needed. Administered and educated client
about their medications. Performed appropriate precautions to ensure
clients' safety and security. Monitored clients' progression and
communicated changes to other healthcare professionals and suggested ways
to improve care for the client. Ordered medical supplies and equipment when
needed.
Registered Nurse. (Jan 2008-
Mar 2010)
New Mexico Department of Health State Hospital, Turquoise Lodge Hospital.
Albuquerque, NM.
?Part time. Managed night shifts, as necessary, by supervising staff and
providing help in emergency situations. Trained employees as needed.
Conducted continuous assessment and monitoring of stages of withdrawal and
delivered proper interventions. Educated patients about the disease
processes and treatments. Utilized listening skills and comforted
distressed patients. Tracked the progress of patients and communicated
relevant findings to other healthcare providers.
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