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Karen
nursekaren1@hotmail.com
407-547-7766
106 Cicero Court
Goose Creek, SC 29445
Appeals Analyst
8 years experience W2
0
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Average rating
26
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Summary

Professional Qualifications

  • Experienced Registered Nurse with skills in Pediatrics, Home Health and Medical Review, including Medicare appeals.
  • Strong organizational and computer skills; motivated and teachable; excellent communication skills, triage, teaching and tutoring in the college setting and Quality Assurance.

Experience
Appeals Analyst, Jurisdiction J
Information Technology
Oct 2019 - Oct 2019
  • Palmetto GBA Review Choice Demonstration training and Quality Assurance coordinator
No skills were added
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Appeals Analyst, Jurisdiction J
Information Technology
Jan 2017 - Oct 2019
  • Performed redetermination claim reviews using Medicare regulatory compliance; B of A claims review; SNF reviews; assist management with projects; InterQual certified; write letters when the claim is denied with mandatory regulations
Case Management Home Health Medicaid Medicare Registered Nurse
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TenderLovingCare
Information Technology
Sep 2017 - Dec 2017
  • Per diem RN, assessing Medicaid insurance members for Case Management.
  • Use of Citrix and Jiva software
No skills were added
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Medical Reviewer II
Information Technology
Sep 2016 - Jul 2017
  • Medical Reviewer II, reviewing pre-claim reviews; abstracting data from Medicare Internet Only Manual (IOM) to perform Home Health claims; provider education and familiar with FISS, HIMR, EMS, and iFlow systems
No skills were added
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Case Manager and Clinical Coordinator
Healthcare
May 2016 - Sep 2016
  • Home visits, educate on disease process, call physicians for orders, lab draws, catheters and wound care, and IV’s
No skills were added
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Adjunct Instructor
Information Technology
Jan 2014 - May 2016
  • Adjunct Instructor for Practical Nursing Program. Lecture, lab and clinical site/skills; Blackboard, Microsoft Outlook and Power Point
No skills were added
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Edit Skills
Non-cloudteam Skill
Education
license
not provided 2020
Nursing
Graff Vocational Technical School 2009
and compact states
Seminole State College
Certifications
R.N
InterQual certification
LPN
Skills
Case Management
2019
2
Home Health
2019
2
Medicaid
2019
2
Medicare
2019
2
Registered Nurse
2019
2