Aide Care Medical Coding

DENITA TATE

Odenville, AL ***** 205-***-**** adrozs@r.postjobfree.com

Professional Summary

Driven, hardworking and Registered Nurse bringing demonstrated patient care and treatment management experience. Adaptable and resilient with strong attention to detail, clinical expertise and Medicare payment experience. Bringing 20 years record of success in nursing and desiring a Nursing position with this company. Medical Coding & Billing Certificate of Completion 05/15/22. Certified AAPC CPC coder.

Skills

. Home care . Chronic disease management

• Acute care expertise

• EMR/EHR

• Preventative health

ICD-10

• Healthcare Common Procedures Coding System

(HCPCS)

• Responsible

Work History

Medical Review RN 06/2019 to Current

Palmetto Gba - Columbia, SC Maintains chain of custody on all documents, follows all confidentiality and security guidelines and completes assignments in a manner that meets or exceeds the contract quality assurance goals

• Used classification manuals to gain additional knowledge of disease and diagnoses processes.

• Completed all paperwork, recognizing any discrepancies and addressing them in a timely fashion.

Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches. Conducts medical record claims review to determine correct coding, utilizing ICD-9-CM, ICD-10, and HCPCS Level II coding principles. Review medical documentation for medical necessity utilizing clinical knowledge and Center for Medicare Services (CMS) policies and guidelines, as well as other state and board regulations.

• Conducts in-depth claims analysis of suspected over-utilizers who are suspect of fraudulent billing

practices, including analysis of Standard Claims Processing files to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare and/or Medicaid payment policies Reviews and completes the required number of claims reviews in accordance to pre-established production standards for the project

• Participates in Quality Assurance (QA) and IRR monitoring as requested

• Complies with departmental policies and procedures

• Complies with Medicare and DOJ guidelines and CMS directives, policies and regulations pertaining to integrity, fraud, overpayments, and the handling and disclosure of information Attends departmental and required education and training programs Reviews information contained in Standard Claims Processing System to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare payment policies . Utilizes the Medicare/Medicaid guidelines for coverage determinations

RN Health Coach 02/2014 to 06/2019 Brookwood Baptist Health Systems - Birmingham, AL

• Discussed such topics as proper nutrition and lifestyle changes to help patients live healthier lives.

• Created individualized care plans for each patient based upon his or her health needs.

Identified Type) and Type) conditions by conducting health screenings and reviewing patient histories. Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities to prevent further disability,

. Observed and documented patient factors such as diets, physical activity levels and behaviors understand conditions and effectively modify treatment plans.

• Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.

• Demonstrated ability to advocate for and strive to protect health, safety, and rights of patient.

• Strengthened training and nursing knowledge by taking part in continuing education programs and

[Type) workshops. . Communicated with healthcare team members to plan, implement and enhance treatment strategies.

• Conveyed treatment options, diagnosis information and home care techniques to patients and

caregivers to continue care consistency. Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.

• Offered exceptional care and support to individuals recovering from acute incidents and dealing with

chronic conditions.

• Implemented care plans for patient treatment after assessing physician medical regimens. . Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent

information breaches.

• Explained course of care and medications, including side effects to patients and caregivers in easy-to

understand terms.

• Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate

non-compliance problems. Educated family members and caregivers on patient care instructions. Educated patients and answered questions about health condition, prognosis and treatment.

RN-FLEXI 03/2012 to 02/2014 Brookwood Medical Center - Birmingham, AL

• Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.

• Reviewed post-operative orders and continuously monitored patients' post-operative vitals, set up PCA and fluids and oriented patients to unit to achieve optimal outcomes. Oversaw delivery of care for all patients on 48-bed medical-surgical unit, providing direct care to up to 7-8 patients, delegating nursing assignments and supervising team comprised of nurses, LPNS, technicians and unit clerks.

• Audited charts and reviewed clinical documents to verify accuracy.

• Advised patients and caregivers of proper wound management, discharge plan objectives, safe

medication use and disease management. . Maintained quality care and comfort for patients with heart failure, pulmonary hypertension and other conditions.

• Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans. Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.

• Collected blood, tissue and other laboratory specimens and prepared for lab testing.

• Implemented interventions, including medication and IV administration, catheter insertion and airway

management.

• Delivered medications via oral, IV and intramuscular injections, monitoring responses to address new

concerns. . Observed and reported patient condition, progress and medication side effects to accurately document

updates.

• Taught patients how to improve lifestyle choices, dramatically reducing chance of symptom

reoccurrence. Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities to prevent further disability, Performed ongoing assessments to evaluate mental health needs, working with multidisciplinary team to develop, initiate, manage and modify individualized plans of care. Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.

• Provided direct patient care, stabilized patients and determined next course of action.

• Managed patients recovering from medical or surgical procedures, including facilitating wound care,

ostomy care, pressure ulcer prevention and pain management.

• Managed care for post-operative patients from initial recovery through discharge.

RN Case Manaager-Field RN 03/2010 to 03/2012 Home Care Plus - Birmingham, AL

. Provided complete care to home health patients, including physical assessments, medication and

chronic disease management. . Advised and coached patients progressing from hospitals, rehab facilities and other medical

organizations to at-home treatment settings.

• Introduced changes to patient care plans based on regular evaluations and patient changes, . Responded to patient requests with appropriate clinical and personal assistance. . Documented patient vitals, behaviors and conditions to communicate concerns to supervising

Administrators. . Took samples such as blood and urine to complete diagnostic and routine assessment tests.

• Delivered oral medications, intramuscular injections and IV fluids to mitigate or resolve patient

symptoms.

• Determined and addresses individual home care needs by completing detailed assessments and

reviewing documentation. . Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic

conditions. Supported personal care needs, including shopping for groceries, cleaning house and balancing accounts.

Delivered after-hours care to patients based on strict role-call rotations.

• Equipped patients with tools and knowledge needed for speedy and sustained recovery.

• Implemented interventions, including medication and IV administration, catheter insertion and airway

management. . Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent

information breaches.

• Managed patients recovering from medical or surgical procedures, including facilitating wound care,

ostomy care, pressure ulcer prevention and pain management.

• Educated family members and caregivers on patient care instructions. Monitored patient reactions after administering medications and IV therapies. Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.

• Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate

non-compliance problems.

• Observed and documented patient factors such as diets, physical activity levels and behaviors to

understand conditions and effectively modify treatment plans.

• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while

managing rapidly changing conditions.

• Demonstrated ability to advocate for and strive to protect health, safety, and rights of patient.

Educated patients and answered questions about health condition, prognosis and treatment.

• Conveyed treatment options, diagnosis information and home care techniques to patients and

caregivers to continue care consistency.

• Communicated with healthcare team members to plan, implement and enhance treatment strategies.

Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities to prevent further disability. Participated in education activities, including evidence-based practice project implementation, nursing competency development and nursing simulation activities.

• Implemented care plans for patient treatment after assessing physician medical regimens. . Strengthened training and nursing knowledge by taking part in continuing education programs and

workshops.

11/2007

RN-Case Manager - Field RN 11/2007 to 03/2010 Gentiva Home Health Services - Birmingham, AL

• Supported personal care needs, including shopping for groceries, cleaning house and balancing

accounts.

• Traveled to patients' homes on daily basis to assess health conditions and provide superior level of

nursing care.

• Provided complete care to home health patients, including physical assessments, medication and

chronic disease management.

• Advised and coached patients progressing from hospitals, rehab facilities and other medical

organizations to at-home treatment settings.

• Educated patients on use and benefits of equipment such as home blood pressure cuffs and glucose meters.

Trained, guided, supported and supervised home health aide care providers.

• Contacted Supervisor immediately when issues arose with at-home patients in effort to find effective

resolutions. . informed physicians of any changes to patients' health or concerns observed during home visits.

• Assessed patients' health conditions and asked appropriate questions to better understand current

feelings.

Took samples such as blood and urine to complete diagnostic and routine assessment tests.

• Delivered after-hours care to patients based on strict role-call rotations.

• Introduced changes to patient care plans based on regular evaluations and patient changes.

• Responded to patient requests with appropriate clinical and personal assistance. . Determined and addresses individual home care needs by completing detailed assessments and

reviewing documentation.

• Delivered oral medications, intramuscular injections and IV fluids to mitigate or resolve patient

symptoms. . Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic

conditions.

RN-Cardiac, MedSurg, and GI Lab(pre/post Procedure 07/2002 to 11/2007 Trinity Medical Center – Birmingham, AL

• Administered nursing care to cardiac patients undergoing diagnostic, therapeutic or emergency

services. Prioritized and revised patient care activities based on acuity of symptoms and patient preferences.

• Conducted initial assessments, documented findings in patient records and notified physicians of

abnormal findings.

• Assisted in diagnosis and treatment of conditions such as unstable angina, cardiomyopathy, coronary

artery disease, and cardiac dysrhythmia. Assessed patients, collecting data and prioritizing cases in accordance with standards, policies, procedures and guidelines. . Utilized variety of technical equipment, including stethoscopes, thermometers and sphygmomanometers, to meet patient needs and prescribed medical therapies. . Cared for culturally-diverse patients, liaising with family members and specialists to address changing

needs and enhance individual experience.

• Liaised with patients following cardiothoracic surgical procedures, providing support and education on

post-surgical care.

• Administered medication, pain management and analysis of patient responses to interventions to

improve individual performance. . Changed dressings, cleaned wounds and monitored vital signs of up to 8 patients concurrently with

focus on quality care. . Equipped patients with tools and knowledge needed for speedy and sustained recovery. . Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted

prescribed treatment strategies. Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention

interventions to control and de-escalate situations. . Vaccinated patients to protect individuals from measles, pneumonia, influenza and other illnesses of concern. Educated patients and answered questions about health condition, prognosis and treatment. Strengthened training and nursing knowledge by taking part in continuing education programs and workshops.

• Managed patients recovering from medical or surgical procedures, including facilitating wound care,

ostomy care, pressure ulcer prevention and pain management.

• Administered different therapies and medications in line with physician orders and treatment plan. . Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent

information breaches.

• Monitored patient reactions after administering medications and IV therapies. Demonstrated ability to advocate for and strive to protect health, safety, and rights of patient

• Implemented interventions, including medication and IV administration, catheter insertion and airway

management

• Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate

non-compliance problems.

• Offered exceptional care and support to individuals recovering from acute incidents and dealing with

chronic conditions.

• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while

managing rapidly changing conditions.

• Conveyed treatment options, diagnosis information and home care techniques to patients and

caregivers to continue care consistency.

• Leveraged feedback and process improvement opportunities to create safer and healthier environment

and increase patient satisfaction.

Education Education

Associate of Applied Science: Nursing 05/2002 Jefferson State Community College - Birmingham, AL

Medical Coding and Billing Class - 01/25/2022 - 05/31/2012 Jefferson State Community College- Birmingham Al

06/2022 -Completion Certificate - Medical Coding and Billing 06/25/22 - Obtained CPC Certification from AAPC

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