Amanda Fontaine

Responsible for appealing denied cases through various levels and insurance carriers Utilize InterQual and MCG criteria to assist in determining medical appropriateness Utilize and research ICD-10 coding for DRG level of payment

Clinical Appeals Specialist - CharterCARE Health Partners- Our Lady of Fatima Hospital, RI, Roger Williams Medical Center, RI, Crozer-Chester Medical Center, PA, Delaware County Memorial Hos - Providence, RI

(2018-08)

• Responsible for appealing denied cases through various levels and insurance carriers
• Utilize InterQual and MCG criteria to assist in determining medical appropriateness
• Utilize and research ICD-10 coding for DRG level of payment
• Proficient in Meditech, Allscripts, Streamline, Cerner, Word, Excel, and Outlook
• Maintain reporting stats of all appealed cases
• Effectively manage workload in overturning of denials to maximize revenue
• Facilitate communication between team and individual medical facilities
• Collaborate with the Directors of Case Management and Medical Director
• Train, precept new employees in department and function independently in a remote position
• Excellent verbal, written and analysis skills

Registered Nurse/Assistant Clinical Director - The Cedars/Cedar Home Health - Cranston, RI

(2015-08 - 2019-01)

• Responsible for coordination of admissions/oversee intake
• Collaboratively plans and coordinates operations, including accreditation and Quality Improvement processes
• Ensures complete, accurate, compliant and timely clinical documentation including OASIS, 485 data elements within OASIS review, goals and problem lists through application of a consistent review process.
• Plans, organizes and directs home care services
• Perform SOCs and revisits as needed
• Provide patient education, health and safety assessments, wound care
• Coordinate multidisciplinary care
• Proficient in Brightree documentation

Registered Nurse - The Miriam Hospital- Main Operating Room - Providence, RI

(2016-03 - 2016-10)

• Ensures that the surgical room is sterile and safe for the patient
• Works side by side with scrub techs to help maintain the sterile field in the operating room
• Prepares the patient for the procedure and handles the preparation for the operating room before the surgery
• Demonstrates strong attention to detail and physical stamina to handle long, arduous work hours

Registered Nurse - Rhode Island Hospital-ICCU Cardiac Stepdown Unit - Providence, RI

(2015-01 - 2016-03)

• Implements, supervises and evaluates the nursing care of each patient using a nursing process and in accordance with established hospital and departmental policies and procedures
• Critical thinking to intervene with appropriate intervention for urgent/emergent care
• Demonstrates understanding of cardiac monitoring equipment
• Provides care for patients on IV drips (ie., Nitroglycerin, Dopamine)
• Assumes care of post cardiac cath patient (diagnostic and interventional), post MI patients, med-surg patients
• Knowledge of hemodynamics
• IV and central line skills
• Phlebotomy skills

Certified Nursing Assistant - Middlesex Hospital- Oncology - Middletown, CT

(2012-07 - 2015-01)

• Valuable member of workforce at a MAGNET recognized institution
• Responsible for up to 10 oncology patients per shift
• Knowledgeable of special precautions (chemotherapy, neutropenia, radiation)

Accelerated Bachelor of Science in Nursing - University of Connecticut

Bachelor of Science in Health Science - Eastern Connecticut State University