Data Entry Utilization Review
Resume:
Jalessa Resume ****
Jalessa R Rogers
Austin, TX,
******.***@*****.***
Summary
● 9+ years in Nursing and Data Entry, 3+yrs of experience as Utilization Review Nurse and HEDIS Review/Abstractor Nurse.
● Microsoft Office Skills including Outlook, Excel, Teams, QSHR, Reveleer, Cotiviti, Rapid, M360,Cerner, Labcorp and Quest portals, MCG, Interqual, Clinical Repository, Adobe, KDJ Pillar, QMRM.
● Ability to type 50 WPM with accuracy of 98%.
Education
● Temple College- Temple TX May 2015 Licensed vocational Nurse
● High School Diploma, Hendrickson High School- Pflugerville, TX Certifications and Licenses
● Licensed Practical Nurse
LVN #326964 Date Expires: 11/30/2024
Skills
● LVN
● Inpatient
● Outpatient
● Case Management
● Benefits administration
● ICD-9/ ICD-10
● Medical Records
● Nurse Management
● Insurance Verification
● CPT Coding
● Medical Office Experience
● Health coaching
● Medication review
● Medical documentation
● Supervising Experience
● Cerner
● Medical Billing
● EMR Systems
● Utilization review
● Charts Abstractions
● Pharmacy Script
Professional Experience
Community Health choice / Medix
Jan 2024- June 2024
HEDIS Over reader I (Contract)
● Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff.
● Complete the IRR/over-read tool in the Software Application, including comments if errors are found. Correct errors identified through an over-read process, including a re-review of charts that may contain similar errors.
● Identify and report abstraction errors and provide measure re- education for the abstractor.
Accenture/ Adecco- Austin, TX
Remote Enrollment Representative - State of Mass
Aug 2023-Dec 2023
.
● Demonstrated understanding of insurance carrier administrative processes and procedures, with experience serving as an advocate for clients.
● Processing enrollments and dis-enrollments of state and marketplace carriers.
● Assisting with billing and payment processing.
Anthem/Lance Soft Inc. - Austin, TX,
Jan 2023 to May 2023
Remote- HEDIS Abstractor/ HEDIS Review Nurse
● Collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database.
● Required to perform research on internal claims systems.
● Responsible for retrieval, review, and abstraction of medical record data, required for a non-complex sub-set of STARS and HEDIS measures as well as entering the data into a quality program tool. Care Link - Austin, TX
2022 to Jan 2023
Utilization Review Nurse PRN (Remote)
● Collaborate with providers by reviewing the level of care appropriateness.
● Provide summary of clinical and ancillary information to designated clinics and the appropriate medical staff member for review and decision making.
● Research and identify information needed to perform assessments (e.g., navigate through resources, clinical data, and databases such like Milliman and Interqual).
Centene - Austin, TX - contract
2021 to 2022
Remote- Utilization Nurse
● Initiated out of network authorization requests for Medicaid, Medicare, and commercial insurance.
● Collaborate with nursing, physicians, admissions, fiscal, legal, compliance, coding, and billing staff to answer clinical questions related to medical necessity.
● Prioritizing and allocating time to effectively achieve project deliverables
● Abstract medical records through multiple databases.
● Worked on special projects
● Comply with all HIPAA compliance rules including Privacy, Security and Breach
● Adhere to State and federal guidelines
● Proficient in Microsoft Office: Outlook, Excel, and Word, Teams, Outbound and inbound fax systems and similar applications efficient in Interqual, MCG.
Other Experience
Cantex Continuing Care Network - Round Rock,
TX
2019 to 2020
Staffing Coordinator- Management
● Prepare "monthly" schedules for all nursing departments
● Maintain a list of open positions via Company job postings
● Perform initial interview of staff
● Complete reference checks; licensure/ certification verification and Employee
● Misconduct Registry on potential new hires prior to employment of individual
● Perform Orientation for staffing personnel
● Report to DON/designee daily of staffing patterns and/ or open positions
● Maintain accurate phone list of nursing personnel
● Handle all staffing calls while on duty M-F
● Perform initial disciplinary action for staffing issues Community Care - Austin, TX
2017 to May 2019
LVN Clinic Nurse
● Made outbound calls to patients to complete telephonic interventions and education for the management of their health, wellness and chronic conditions.
● Educate patient on medication administration, case management for chronic diseases
● Complete referrals, prior authorizations as well as help coordinating patients with outside sources to help with economic hardships.
● Medical record review before previous visit.
● Medical record abstract
● Immunized patients ranging pediatrics to geriatrics Wesleyan Homes - Georgetown,
TX 2015 to 2017
Charge Nurse
● Administers basic nursing care to Residents in accordance with facility's policies and procedures.
● Thoroughly assesses Residents and responds according to Nursing Standards of Practice.
● Plans and implements Resident care according to Care Plan.
● Performing health assessments and monitoring in-patients.
● Maintaining and updating patient records.
Baylor Scott and White - Round Rock,
TX May 2015 to Apr 2016
Clinic Nurse
● Performs assigned nursing duties, including assessing, planning, implementing and evaluating patient care, under the direct supervision of an RN/Physician.
● Maintaining and updating patient records.
● Collecting information and samples for diagnosis. Pro Lab Incorporated - Austin,
TX Jan 2013 to Apr 2015
Phlebotomist
● Primarily responsible for the timely and correct collection of Specimens requested by ProLab clients.
● Identifying patients via ID, medical record or other means.
● Drawing blood using needles and other equipment.
● Labeling samples correctly and send them for testing.
Contact this candidate