Medical Billing Quality Manager

DENISE MOORE LPN

*** **** **** ****** ********, New York

347-***-**** (cell)

**********@*****.***

OBJECTIVE

Dedicated and well-qualified healthcare professional with hospital, nursing homes, home healthcare and doctor’s office experience. Excel in hardworking independently, professionally managing caseloads, and setting priorities.

Highly adaptive, flexible style; efficiently and competently work with diverse patient populations

Demonstrate a solid understanding of HIPPA and regulatory compliance an ability to skillfully navigate Health Plan Employer Data Information Set

(HEDIS) and Quality Assurance Reporting Requirements (QARR) Page 2

SKILLS & ABILITIES

Patient Dialysis post-surgical and wound care. Home Care of the elderly and children of all ages in the home

Supervised 5 or more per day home attendants and certified nurse’s aide Utilize Med Capture, Facet Claims, Inovalon, Catalyst Systems and City-Wide Immunization Systems. CIR to capture medical data and claims information. MS office, windows 7, Excel, Access, Outlook

Claims/MR Review/ Medical Billing/ Call Center

Extensive knowledge of Network and Provider populations Certifications: Hemodialysis, BLS, and IV placements EMPLOYMENT ADDENDUM

10/20- 04/21 LPN Clinician Testing For Covid 19 Rapid testing for CVS Pharmacy

11/20-present LPN Clinician for covid vaccinations for DOH in various clinics thru out NYC. Gave Moderna vaccinations. Administered vaccinations, observe clients post vaccination and made 2nd appt for 2nd vaccination. Do Page 3

EMPLOYMENT HISTORY

05/2015-present LPN Charge Nurse 5 Star Nursing Agency I work in SNF and HRF floors giving treatments, dispense medication, feed residents with NGT (nasogastric tube) via nasally & gastro, take vital signs, chart via computer using

01/2015-

05/2015

01/2006-

05/2014

09/2014-

12/2015

01/2012-

12/31/2013

04/2007-

02/2012

LPN Quality Assurance Improvement Reviewer United Health Care Grp. Did HEDIS Data Collection

Perform duties as assigned by United Health Care Clinical Quality Manager(s) for market specific annual collection efforts. Conducted Claims Research, determining correct service location or verifying member history.

Follow-up on requests within HEDIS database tool, request medical records both written and verbally.

Maintain HIPPA standards and confidentiality of protected information. Conduct telephonic and provider visits and collecting and reviewing member’s medical records for completeness.

LPN Quality Assurance Improvement Reviewer Amerigroup/Health Plus I had the same duties that I had when I worked at United Health Care Group.

LPN Home Care for adults and children

I did tracheotomy care, vents and suctioning care in clients’ homes. Charting and administration of medications

Positioning and turning bedridden clients

I did tube feeding management via pump and manually in bolus form LPN Manhattan School of Computer Technology

I was a teacher training men and women in becoming a CNA’s days and evenings. I also proctored the trainees for internship in designated nursing homes so they can get experience in real time on how to apply what they learned in the classroom and to pass the test required for certification. LPN Gotham Per Diem Inc. Respite Care for infants and toddlers. Assisted with feeding, sunctioning & trach care

Page 4

05/2015-present LPN Charge Nurse 5 Star Nursing Agency I work in SNF and HRF floors giving treatments, dispense medication, feed residents with NGT (nasogastric tube) via nasally & gastro, take vital signs, chart via computer using

09/2003-

092008

LPN FFS Home Care Revisits

Working under a RN doing revisits mainly to residents in HIV/AIDS clients who were not in compliance with their HIV medications in order to lower their viral load. I pre-poured meds, did finger stick to monitor blood sugar and administered insulin as per MD order. I met with MD’s and RN in order evaluate the residents care and changes weekly.

1967-1970

2018-

present

2017-2018

HS Diploma and Practical Nurse Certificate from Clara Barton VHS in Brooklyn New York

Bronx Community College for Psychology Major

New York City College of Technology

Certification for Patient Care Navigator

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