Practical Nurse Health Insurance
Resume:
JODIE
REICH
Myerstown, PA *****
********@*******.***
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
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