Shreveport Programs

GlendaJ.Walker

***AlamoCourtDesoto,

Texas*****

phone:318-***-****

Email:*********@*****.***

Education

SouthernUniversity,Shreveport,LAAssociateofScienceinNursing,December,2011 WileyCollege-2014BusinessAdministrationwithConcentrationOrganizationManagement LouisianaTechnicalCollege,Shreveport,LA-2001LicensePracticalNursing LicenseHealth&LifeInsuranceBrokerAHIPCertificationAetnaCertification Priamerica-7/2025-Present-IndependentInsuranceAgent SilverstoneHealthCare-04/2025-Present-ClinicalCareCoordinator/IntakeCoordinator AdmissionforHomeHealthPatientsEvaluatereferralsagainstbranchservicemodeInsurance Verification/PriorAuthorizations.

ReviewofHomeHealthServicesSchedulingofNewPatientAdmitProcessallrequired paperworkaccordingtoestablishedprocedures.

Ensurealldocumentationneededforbillingiscollectedpriortoadmit. EvaluateF2F.

Communicateswithvariouspayers,referralsources,patientandsalesrepresentativesVerifies eligibilityandbenefitsaccuratelyandinatimelymannerinaccordancewithCompanypolicy. Answertelephonesandemailsinatimelymanner.Assistwithcommunityresources/Outreach Programs.

OrderingofDME

SymmetryFinancialGroup-7/2024-Present-IndependentLicenseHealth/LifeInsurance Agent.

CareCentrix-11/2022-06/2025

UtilizationManagement-ClinicalReviewClinicalReviewersareresponsiblefortheUtilization Managementandreviewofclinicalinformationforservicerequestsreceivedandtorendera medicalnecessityapprovalorrecommendeddenialtotheMedicalDirector.Aspartofthis process,youwillevaluateinformationconcerningpatientcareandmatchthoseneedswith availablecareoptions,consistentwithCareCentrixguidelinesandspecificplanpayercriteria.

●PerformaninitialevaluationofthereferralappropriatenessforCareCentrixservices.Review forinformationneededtomakeamedicalnecessitydetermination.

●Requestadditionalclinicalinformationwhenneededtorenderadecisionanddeterminenext steps.

●Useclinicalexpertise,reviewclinicalinformationandclinicalcriteria(e.g.,CMS,MCGs, Interqual)todetermineiftheservice/devicemeetmedicalnecessityforthepatient. CareCentrixservices.Reviewforinformationneededtomakeamedicalnecessity determination.

●Requestadditionalclinicalinformationwhenneededtorenderadecisionanddeterminenext steps.

●Useclinicalexpertise,reviewclinicalinformationandclinicalcriteria(e.g.,CMS,MCGs, Interqual)todetermineiftheservice/devicemeetmedicalnecessityforthepatient.

●Ensurecasereviewandelevationtocompletethedeterminationisrenderedwithinthe contractualandregulatoryturnaroundtimestandardstomeetbothcontractualandregulatory requirements.

●InteractwiththeMedicalDirectorasneededtoensurepropermedicalnecessitydecisionsare beingmadeinatimelymanner.

●Develops/maintainsaworkingknowledgeofallCareCentrixservices/guidelines/policiesand accessesCareCentrixcontractinformation,includingthetermsofthecontractasappropriate. AngelsofCare PediatricHomeHealth-2022-2023

Delivercareinthehometoclientsoratschool.

WillisKnightonMedicalSystem-08/2018-July/2021

ClinicNurse

DeliveringofPatientCare

AdministeringTreatments

MonitoringVitalSigns

PerformingTesting

SchedulingProcedures/PriorAuthorizationsElectronicHealthCareRecordDocumentation CommunicatewithPatientandProvidersOrderingofCommunityResourcesObtain Prior-AuthorizationforMedicationsandProceduresChartReview HUMANA-12/2018-July31,2020

CAREMANAGER/UtilizationReview

Provideeffectivecarecoordinationspecifictotheentirelyofthecontinuumofcare. AssistwithFacilityDischargesandHomeHealth.

ReconcileMedicationswithHumanaPharmacist.

CommunityResourceReferrals.ScheduleMDAppointmentsasneeded. CoordinateDailyCarePriorauthorizationsandAssessmentofInsuranceClaims. STATHomeHealth-03/2018-12/2018IntakeCoordinator/FieldNurse-PRNCoordinates AdmissionforHomeHealthPatientsEvaluatereferralsagainstbranchservicemodeInsurance Verification/PriorAuthorizations.

ReviewofHomeHealthServicesSchedulingofNewPatientAdmitProcessallrequired paperworkaccordingtoestablishedprocedures.

Ensurealldocumentationneededforbillingiscollectedpriortoadmit. EvaluateF2F.

Communicateswithvariouspayers,referralsources,patientandsalesrepresentativesVerifies eligibilityandbenefitsaccuratelyandinatimelymannerinaccordancewithCompanypolicy. Answertelephonesandemailsinatimelymanner.Assistwithcommunityresources/Outreach Programs.

OrderingofDME

GastrointestinalSpecialist&ShreveportEndoscopy-06/2016-07/2018Recovery/Nurse UtilizationReview/QualityAssurance.

NursePatientAssessment,

MonitorVitalsIV,

TherapyDocumentProgressofPatient’sconditionandprovideadequatenutrition. AssessmentofAdmission,/CaseReview/ClinicalResourceforEndoscopyProcedures BlueCliffCollege-10/2014-12/2017ProgramChairDirector/LeadInstructor-Externship Coordinator

ManagesInstructorsAssistwithplanningjobplacementOverseeExternshipstudentsdoing clinicalrotation

STATHomeHealth/ST.JosephHospice-10/2013-12/2018-PRNCareTransitionCoordinator EducationofHomeHealth,AIM,Hospice.VerifyingIns.OrderDME,AdmissionCoordinator, CoordinatingServicesWithAssistedLiving,SkilledNursingFacilitiesandLTACProviding In-serviceTrainingfortheCommunity,Mdoffices,SW/CM/DischargePlanners,DeliveryMeals onWheels,WorkingwithCaddoCouncilAgingfortheseniors DubuisHealthSystem-06/2012-10/2013-ClinicalLiaison/UtilizationReviewNurseMarketing, AssessmentPriortoadmissiontoLTAC,DischargePlanningAssessmentofIn-patientcontinue statusCommunicationwithInsuranceforApprovalofServicesReviewmedicalrecordsto determinethemedicalnecessityofUtilizationReviewrequests.Obtainadditionalmedical informationfromproviderswhenapplicable.ExplainedUtilizationReviewDecisionstoProvider, InsuranceClaimantandCarrierwhenapplicable.

SmartHealthcare,Shreveport,LA-12/2005-09/2007Responsibilities:ClinicalLiaison; marketedhealthcarefacilities;physicians;SW;Retirementhomes,assistedlivingsforHome Healthpromotedhealthfair;throughoutthecommunity.AssistedwithCommunityServiceOut ReachPrograms.SchedulingofAppointmentstoMDoffices

St.Luke’sRehab,Shreveport,LA-06/2003to12/2005Responsibilities:Marketingdirector, supervisedmarketingdepartmentandclinicalliaison;AssessmentNurseforacutein-patient rehab;30bedManagementofInsapprovalpriortoadmit,andWorkmanCompClaim. CaddoParishSchoolBoard,Shreveport,LA-08/2001-6/2003-Responsibilities:Directed one-on-onesupervisionwithamechanicalventilatorstudent;trachcare;suctioning,asneeded andrespiratorytreatmentsasneeded.

Schoolnurseinaspecialeducationclassromm.

CertificationsIVtherapyCPRCertified

Skills

GoodorganizationalandmanagementskillsCommunicationandsupervisoryability ExperiencedinICD10Coding,ExcelGoogleDocs

ExperienceinVariousEMRDocumentation,NextGen,Homecare/HomeBase,Epic,Home HealthNotifyApp,WellSky/Kinnser.

MarketingPlansandBudgets

BasicCodingandInsuranceApprovals

ManagementofWorkmanCompClaimsandFilesExperiencedinverificationofMedicare, Medicaid,andCommercialIns.

ICD10MedicalBillingandCoding

CompletionofHealthCoach2014

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