Medical Nurse

Kerry McNamara

LPN/ Medical Reimburement Specialist

West Seneca, NY 14224 ***************@*****.*** 716-***-****

Work Experience

Utilization Management Clinician LPN- Fidelis Care

May 2019- Present

Uses MCG, NYS Medicaid guidelines to review medical necessities for procedures, medical supplies, and other services supplied by member’s insurance plans.

Communicates with members and providers regarding their eligibility and right for appeals/reconsiderations.

LPN/ BILLING SPECIALIST

ORCHARD PARK DERMATOLOGY

October 2012 till January 2019

•Provides excellent patient care, ranging from completing medical history, documenting medical notes, telephone triage, scheduling surgical procedures, administer medications for surgeries and local anesthesia

•Manages billing office including the input of all medical claims from start to finish. Follows up with patients with questions regarding their insurance coverage. Verifies insurance coverage prior to appointment. Submits prior authorizations to insurance companies.

Hedis Nurse Chart Reviewer

Blue Cross Blue Shield of WNY/Amerigroup

January 2019-May 2019 (temporary hire)

Abstract appropriate data from patient charts that meets the qualification of specific HEDIS measures

Pays close attention to detail

Faxes and contacts medical offices to obtain records through pick up, fax, or onsite

Education

ASSOCIATES DEGREE in Medical Reimbursement & Coding

BRYANT & STRATTON COLLEGE August 2019

Certifications/Licenses

LICENSED PRACTICAL NURSE

OTHER SKILLS

•Proficient in Microscoft Word, Excel, Outlook

•Medent Experience in scheduling appointments, inputting and submitting claims, posting personal and insurance payments, managing A/R

•Fluent is ICD 10 and Proper CPT coding

•Experienced in Facets, Filenet

Contact this candidate