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Justin
JFSamiee@gmail.com
305-903-2705
Miami, FL 33158
RN - Appeals Analyst/Denial Prevention
10 years experience
W2
0
Recommendations
Average rating
41
Profile views
Summary
Computer Skills
Advent Health: Cerner, CPA, Experian, Athena, Sunport, HealtheRegistries, Discern reports
McKesson InterQual
Humana: eCW
HCA: Meditech-CPOE
Baptist Health Charting: T-system, Net Access
Microsoft Office Suite, Windows OS 95/98/2000/NT/XP/Vista/7/10, MS Project, Visio, SQL Server
Knowledge of PC Repair & Assembly, Networking, as well as TCP/IP, HTTP, FTP
Softwares/Systems
Lotus Notes, ACT!/Salesforce, Business Objects, Adobe Premiere, Adobe Photoshop, Real Producer, Flash, Fireworks, Dreamweaver, Flash Server, QuickBooks, AutoCAD, Norton Ghost, Trackit!, Crystal Reports, Subversion, VMware, Nero, Tandberg IP Conferencing MS
Experience
RN - Appeals Analyst/Denial Prevention
Medical Devices
Mar 2019 - present
Evaluate denials and non-certified days from 3rd party payers to determine appropriateness of denial and feasibility of appeal.
Reviews surgery cases to ensure appropriate CPT, LOC, Relevant testing, authorization and medical necessity is present in the EMR prior to billing.
Clinical resource for pre-access, billing/coding, patient financial services
Familiar with CPT, ICD-9 &-10 & DRG coding
EMR
Registered Nurse
Appeals
Remove Skill
Quality Improvement RN
Dec 2018 - Mar 2019
Reviewed charts and abstracted clinical data from various EHR's
Identified and closed gaps under ACO\CMS quality measures
Assisted with reporting in compliance with initiatives and standards
Compliance
Registered Nurse
Remove Skill
Registered Nurse Managed Care / Medical Management
Medical Devices
Jun 2015 - Sep 2018
(Telecommute) / HEALTHNET VA FEDERAL SERVICES Registered Nurse Managed Care / Medical Management Utilization Review Nurse, Care Coordination, Provider Relations
Utilized McKesson InterQual Criteria, performing first level clinical reviews for all inpatient and ancillary services requiring authorization.
Assisted in requirements gathering for policies and procedures, internal audits, and reporting
Completed 20+ discharge calls daily to decrease re-admittance and hospitalization and to ensure post-op care is followed.
Performed case management, disease management, and care coordination for veterans between PCCC and non-VA providers.
Post-op
Registered Nurse
Veterans Affairs
Audit
Nursing
Remove Skill
Registered Nurse Supervisor - Frontline Leader
Medical Devices
Sep 2013 - Feb 2015
Miami, FL
Collaborated with clinicians and administration to provide efficient and effective quality of care.
Reviewed actual and proposed medical care and services against NCQA established guidelines.
Performed as the HEDIS liaison and implemented quality improvement initiatives in adherence with STAR measures.
Assisted billing and coding with clinical charting quality and standards, CPT, and ICD coding.
Supervised Medical Assistants as well as non-clinical staff.
Participated in the development, implementation, and interpretation of nursing policies and procedures.
Registered Nurse
Nursing
Remove Skill
Registered Nurse (Medical Surgical/Telemetry/Orthopedics)
Medical Devices
Aug 2012 - Aug 2013
Aventura, FL
Managed patient care while working with physicians, case management, physical therapy, respiratory, nursing aids, monitor techs, and many other disciplines to provide excellent patient outcomes.
Assessed patient's condition based upon observation of patient and interview of patient and family, physician's diagnosis and data, diagnostic results, and relevant data from other healthcare providers.
Documented all aspects of patient care and maintained patient records, including but not limited to, core measures and patient safety.
Provided patients and family members with relevant healthcare education and instructions regarding treatments and procedures including pre-and post-hospital care as appropriate.
Orthopedic
Registered Nurse
Nursing
Remove Skill
Nurse Scholar Partner
Medical Devices
Jan 2011 - Jul 2012
Miami, FL
Program Employee (Emergency Department, Cardiology, Medical surgical)
Assisted Emergency Department Nurses in all facets of RN responsibilities: patient management and care and documentation/charting to reflect standards of care.
Cardiology
Registered Nurse
Nursing
Remove Skill
Edit Skills
Non-cloudteam Skill
Education
secure file server
Florida International University 2003
Record has not been verified.
Management Information Systems
Florida International University
Record has not been verified.
Nursing
Florida International University
Record has not been verified.
projects that created an in-house IPCC
learning center
Record has not been verified.
Certifications
CPA
License Information
Licensed Registered Nurse, Multi-state License
FL License # RN9345474, Exp:
Skills
Registered Nurse
2021
8
Nursing
2018
7
Audit
2018
3
Post-op
2018
3
Veterans Affairs
2018
3
Appeals
2021
1
Cardiology
2012
1
EMR
2021
1
Orthopedic
2013
1
Compliance
2019
1