JODIE

REICH

Myerstown, PA *****

717-***-****

ady389@r.postjobfree.com

PROFESSIONAL SUMMARY

Highly trained LPN/Insurance Coordinator with 10+ years of expertise in securing prior authorizations and processing appeals/grievances for prescription medications including high priced specialty medications. Expertise with verifying insurance eligibility for Medicare/Medicaid and all health insurance plans along with authorization guidelines. Extensive Medicare/Medicaid and commercial health insurance knowledge. Excellent interpersonal skills with proven history of interpreting and explaining health insurance policy details to patients. Proficient in medical terminology and CPT, ICD-10 and HCPCS coding. Excellent documentation skills. Skilled in quickly resolving issues and liaising between insurance providers and policy holders.

SKILLS

• Documentation • Case management • Critical thinking

• Task prioritization • Time management • Reliability

• Problem solving • Insurance verification • Medical billing and coding

• Insurance claims and denial

processes

• ICD-10 coding • Excellent administrative abilities

• Prior authorization processing • Thorough knowledge of patient assistance programs

EXPERIENCE

Clinical Review Nurse

CareCentrix Hartford, Connecticut

July 2022 - July 2023

• Performed initial evaluation of sleep service referral for appropriateness.

• Reviewed information needed to make a medical necessity determination.

• Requested additional clinical information needed to make a determination.

• Used clinical expertise, reviewed clinical information and clinical criteria (CMS/MCG's) to determine if service request meets medical necessity criteria.

• Approved or elevated case to Medical Director for further review. Maintained working knowledge of insurance guidelines/policies. Triage LPN / Insurance Coordinator

Wellspan Pulmonary and Sleep Medicine Ephrata, Pennsylvania July 2012 - February 2022

• Maintained compliance with local, state and federal regulations governing insurance, Medicare and Medicaid requirements.

• Verified insurance and communicated coverage to staff and patients.

• Obtained prior authorization and precertification for outpatient procedures and high-cost biologic medications.

• Contacted insurance carriers to discuss policies and individual patient benefits.

• Prepared insurance claim forms or related documents and reviewed for completeness.

• Assured timely verification of insurance benefits prior to patient procedures or appointments.

• Maintained confidentiality of patient finances, records and health statuses. Licensed Practical Nurse

Central Penn Nursing Care Inc. Lancaster, Pennsylvania June 2011 - July 2012

• Collaborated with interdisciplinary team of healthcare and social service providers to address patients' needs through effective intervention and care planning.

• Collaborated with supervisor to assess patient needs, plan and modify care and implement interventions.

• Performed routine evaluations of each patient's status, needs and preferences. Home Care Licensed Practical Nurse

Hospice of Lancaster County Lancaster, Pennsylvania May 2003 - December 2007

• Identified and coordinated patient and family care to support patients and families in home or assisted living facility.

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

• Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.

• Followed all personal and health data procedures to effectively comply with HIPPA laws and prevent information breaches.

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

Diploma LPN - Practical Nursing

Lancaster County Career and Technology Center, Willow Street, Pennsylvania February 1997

Professional license

- LPN licensed in state of PA since September 1997