MARITA DOCTOLERO

DNP, RN-BC, CCDS, CDIP 773-***-**** adwhhv@r.postjobfree.com

Doctorally prepared registered nurse with experience in Clinical and Coding Denials and Appeals as well as Clinical Documentation Improvement. Dual certified as a CCDS and CDIP. Proficient in various EMR platforms (EPIC, Powerchart, Meditech) and CDI/Coding tools (3m 360, 3M CAC, Iodine, Nuance) as well as Microsoft Office products. Years of experience: Clinical and Coding Appeals: 2 years, CDI: 7+years, Case Management/UR: about 1-year, Bedside Nursing: 7-years Units/Clinical Strengths: ICU – Medical and Surgical, Neurology, Neurosurgery, Cardio- thoracic surgery, Orthopedic, Trauma, Oncology, Cardiac-Telemetry EDUCATION

• Doctor of Nursing Practice (05/2022), Major: Executive Leadership Chamberlain University, Chicago, IL

• Master of Science (08/2014), Major: Nursing Informatics Chamberlain University, Chicago, IL

• Bachelor of Science (05/2007), Major: Nursing

Trinity Christian College, Palos Heights, IL

PROFESSIONAL CERTIFICATIONS AND LICENSES

• Certified Clinical Documentation Specialist (CCDS) – ACDIS (CD1800040)

• Certified Documentation Improvement Practitioner (CDIP) – AHIMA (#225303)

• Certified Nurse Informatics (RN-BC) – ANCC, (202*******)

• State RN Licenses: Illinois (#041361451), Nevada (#820237), Texas (#1052822) PROFESSIONAL EXPERIENCES

Clinical and Coding Appeals Nurse (06/2022-present) Catholic Health Systems, Buffalo, NY (Consultant as part of Medovent Solutions)

• Performs clinical and coding reviews ensuring accurate clinical documentation and coding compliance.

• Constructs strong appeal letters supported by medical references, coding guidelines, and/or coding clinic.

• Medical necessity appeals using MCG criteria and/or partnership with physician advisors.

• Facilitates communication between payors and physician advisors when peer-to-peer call is warranted.

Clinical Documentation Specialist (05/2019 – present) HCA Far West, Nashville, TN

• Performs initial and follow up chart reviews using Iodine, 3M 360, and Meditech for accuracy and clarity, assigns appropriate DRG and send clarifications as needed. 2

• Generates and follows up queries via 3M 360.

• Mixed population review from various units Neuro and Cardiac ICU, Stoke, Telemetry, Orthopedic Trauma/Surgery and Medical/Geriatrics.

• Mortality review using 3M CAC.

• Incorporates PSI/HAC reviews and POA clarification with concurrent reviews to help facilitate timely completion of chart coding.

• Discuss DRG mismatch with second level centralized reviewers needed.

• Coordinated with case management about high priority long stays DRG and update needs for physician clarification as needed.

Denials Auditor/Educator Clinical Documentation (06/2021-04/2022) Baylor Scott & White Health, Temple, TX [Brundage Workforce – 3 months as consultant]

• Performed clinical and coding reviews for physician-related and CDI-related denials.

• Tracked and communicated audit results with CDI team and various leaders.

• Identified opportunities for process improvements.

• Prepared and presented CDI educational materials for both physicians and staff.

• Partnered with Data Analytics team to create efficient CDI dashboards.

• Maintained physician education dashboard and tracking.

• Co-managed physician education modules - collaborated with Denials Resource staff for second level review of complex cases and provided evidence-based support for appeals. Clinical Documentation Specialist (04/2018 – 05/2019) NorthShore University Health System, Evanston, IL

Units: Orthopedic and Orthopedic Surgery, Medical ICU Clinical Documentation Specialist (05/2017 – 04/2018) Advocate Lutheran General Hospital, Park Ridge, IL Units: Oncology/Stem Cell transplant, Chronic ventilator, Medicine Withdrawal Clinical Documentation Specialist (10/2015 – 05/2017) Loyola University Medical Center, Maywood, IL

Units: Neurosurgical/Neurology ICU and CV-Thoracic ICU Case Manager/Utilization Review Nurse, Inpatient Units (10/2014-10/2015) NorthShore University Health System, Evanston, IL

Resource Nurse, Inpatient and Ambulatory Unit (02/2010 – 10/2014) NorthShore University Health System, Evanston, IL

Staff Nurse II, Cardiac and Surgical Surveillance Unit (11/2008 –05/2012) Advocate Illinois Masonic Medical Center, Chicago, IL Staff Nurse, Telemetry and Ventilator Unit (08/2007 – 11/2008) Mount Sinai Hospital Chicago, IL

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