Management Nurse
Resume:
Lisa Compton, RN
**** *** ***, *** *******, TX **232
*********@***.***
CAREER SUMMARY
A Healthcare Leader with over fifteen years of progressive leadership and management experience. A proven leader with an intense focus in building positive hospital department relationships, fostering physician relationships, quality management, reduction in denial costs, positive impact on DNFB and productivity enhancement. Denial defense expertise, process expert, strategic denial reduction planning & re-engineering with the ability to initiate positive changes.
EDUCATION
2017 BSN University of Phoenix
1989 ADN Hardin-Simmons Abilene, Texas
PROFESSIONAL EXPERIENCE/ACHIEVEMENTS
2015 – Current MedPartners Consulting
Munroe Regional Hospital, (Community Health System) Current Assignment
Denial Management Nurse Consultant
Munroe Hospital is 420 bed hospital located in Ocala, Florida
At the request of Community Health System Corporate Case Management, design and implementation of a Denial Management Department reporting to the CFO and working in conjunction with the Central Business Office and the Case Management Department
Long Island Jewish Health, (Northwell Health) Assignment: October 2015 thru 2016
Denial Management Nurse Consultant
Long Island Jewish Hospital System, not-for-profit teaching hospital serving the greater metropolitan New York area. RAC 2nd Level Appeals Nurse for 11major hospitals; Outpatient Chemotherapy Denials for the Monter Cancer Center; Reports to VP of Revenue Cycle.
Development of Patient Safety Indicators (PSIs) Database
Physician Education for Clinical Documentation Improvement
Reduction in DNFB through 1 day stay Audits
Focus on 2 Midnight Rule Case Management Education
Process Improvement Implementation Project for Montier Clinic
2014 – 2014 Abilene Regional Hospital Abilene, Texas
Nurse Supervisor Women & Children’s Services/Interim Department Director
200+ bed for profit hospital; Improved Case Management & Admitting process ensuring correct patient status due to increase in patient volume; Member of Unit Base Council & March of Dimes
Oversite of 5 Departments & 95+ Employees
32 Bed Antepartum, Postpartum beds
12 Bed Labor & Delivery
16 Bed Level III NICU with full transport service – only one in 150 mile radius
140 Deliveries per month
Increased by 40% with the addition of two established OB-GYNs
Employee base increase by 30%
Implementation of Employee Orientation Program for new Graduates
2008 – 2014 Baptist Health System San Antonio, Texas
Director Denial Management Department
Recognized leader in Healthcare with 5 acute care facilities in San Antonio encompassing over 900+ beds, 2 facilities in the Valley; Recognized as high-performing in services for COPD, Colon Cancer Surgery, Heart Failure, Hip & Knee Replacement; Reported to VP of Business Services
Project Manager - Denial Management Department
All Inpatient Denials, HIM Audits, RAC & State Medicaid Audits
$1.7 million recovered in the first year
75% Recovery rate across all lines of Business
100% Recovery Rate with Medicare’s ALJ
100% Reduction in CMS Focus Study Audit for Orthopedics
Active Participant in Medicare Demonstration Project for Cardiology & Orthopedics
Extensive Physician Teaching
Contract Negotiations with a 45% reduction in Admission Denials
Pre-Denial Pilot Program with a savings of $22 million dollars over nine months
Reduction in DNFB with Process Improvement for 1 day stays
Denial Management Orientation for All 28 Vanguard Facilities
2005 – 2008 Humana Healthcare San Antonio, Texas
Supervisor of Outpatient Appeals
Oversite for all Southern & Western US Region for Humana PPO, HMO & Humana Medicare, from Texas to Hawaii; Previous Appeal Nurse Liaison for VIP Fort Automotive Contract for the states of Kentucky and Ohio prior to promotion to Outpatient Appeals.
3 calendar day turn-around time for all Appeal Requests
Worked with Automotive Union Reps in Kentucky & Ohio
Responsible for all regulatory compliance URAC, & ERISA governing Appeals
Implementation of IT tracking program for Appeal deadlines
2004 – 2005 Muro Health Consulting San Antonio, TX
Nurse Administrator Ryder HMO Family Practice Medical Group
Delivering care to thousands of seniors with Secure Horizons, UHG. Direct oversite for all clinics & clinical as well as non-clinical employees. Actively worked with Marketing initiatives to recruit & maintain members.
9 Clinics
16 Physician; 1 PA
85+ Employees
Implemented centralized nurse triage for all clinics; decrease hold times by 40%
2000 – 2004 NorthEast OB-GYN San Antonio, TX
Nurse Manager
Established OB-GYN Practice since 1977. Direct clinical oversite for all locations. Supervision and training for all clinical employees
4 Clinics
25 Clinical Employees
9 Physicians seeing approximately 100 patients per day per clinic
Revision of Policies & Procedures
Responsible for all hiring, training & termination for all clinical employees
1989 – 2000 Various Nursing Positions San Antonio & Abilene, Texas
Charge Nurse, Family Planning Supervisor, Private OB-GYN Clinic Nurse
27 as a Registered Nurse
16 of Managed Care & Commercial Experience
6 years Revenue Cycle Experience
Worked in all areas of administrative health care:
Inpatient hospital
Outpatient physician office administration
Public health
HMO physician practice.
Valedictorian of Nursing Class 1989
References Available Upon Request
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