Precertification Nurse, LPN at GLOBAL HEALTH INSURANCE LLC (2024-05 – Present)
Manages pre-service requests of services and ensures timely determination. Communicates with customers regarding status and referral processes.
- Review pre-service requests of services, and ensure timely determination.
- Communicates with customers, both internal and external, regarding status/referral process.
- Utilizes NCDs, LCDs, MCG, and additional guidelines to assist in determining coverage of the request.
- Maintains current knowledge of managed care issues (benefits, contracted providers, health plan guidelines, MCG, NCD, LCD and community standards of practice and regulatory developments, and new and experimental procedure.)
- Collaboration with internal teams to support member needs, including but not limited to discharge planning, provider relations, and care management.
Physician Substitute/Licensed Practical Nurse at FREEDOM PLASMA (2022-10 – 2023-10)
Conducted screening procedures for plasma donors and determined eligibility through comprehensive assessments. Handled medical emergencies and maintained compliance with regulatory standards.
- Greet and register new plasma donors into the donor management computer system.
- Conduct screening procedures to include taking blood pressure, pulse, temperature, weight, and arm checks.
- Perform finger sticks to test donors for hematocrit testing and total protein testing utilizing screening equipment.
- Monitor the electronic donor questionnaire system.
- Determine donor eligibility by performing donor eligibility assessments, to include; medical history interview, physical examination, educating donor on donor testing, HIV/AIDS virus, donation risks, informed consent, confidential self-exclusion, and reviewing Serological Protein Electrophoresis (SPE) testing as necessary.
- Provide counseling to Donors regarding unacceptable test results.
- Initiate and assist in donor investigations regarding Post Donation Information.
- Evaluate and attend to donor adverse events during the donation process.
- Follow all standard operating procedures for all medical emergencies, to include communication with the Center Medical Director and donor transport to emergency medical care facilities.
- Communicate and seek direction from Center Medical Director and Center Management as necessary.
- Learn and maintain thorough familiarity and compliance with all state and federal regulations, Standard Operating Procedure Manual, Occupational Safety and Health Administration (OSHA), Clinical Laboratory Improvement Amendments (CLIA), Current Good Manufacturing Practice (cGMP), and internal Company Procedures.
Licensed Medicare Insurance Agent at ASSURANCE IQ, LLC (2021-04 – 2022-10)
Sold Medicare Advantage, Medicare Supplement, Prescription Drug Plans and other ancillary insurance products to consumers through inbound calls with work from home flexibility.
- Sold Medicare Advantage, Medicare Supplement, Prescription Drug Plans and other ancillary insurance products to consumers through inbound calls.
- No cold calling involved and work from home.
- Licensed in AL, GA, TN, MS, LA, NC, SC, VA, WEST VA, NY, TX, PA, MI, MN, NE, IL, MO, KY, OH, AR, CO, IN, IA, KS, NM, NC, WA.
Insurance Producer at INDEPENDENT INSURANCE CONTRACTOR (2020-08 – 2021-07)
Independent Insurance Broker selling various insurance policies including Life, Accidental, Disability, Mortgage Protection, Final Expense and Health and Sickness.
- Independent Insurance Broker Licensed in AL, GA, IA, LA, MI, MN, NE, OH, SC & TX.
- Selling a variety of insurance policies for several insurance companies.
- Sold several policies such as: Life, Accidental, Disability, Mortgage Protection, Final Expense and Health and Sickness.
- Perform detailed individual needs analysis ensuring suitability of proposed insurance products and product strengths and benefits.
- Reviewed medication lists and summary of plan benefits to ensure client is adequately informed of all costs that might be incurred prior to making a plan selection.
Precertification Nurse, LPN Team Lead at PROXSYS/ATHENA HEALTH, INC. (2007-11 – 2013-11)
Team leader for five pre-cert nurses managing precertification requests for multiple hospitals across several states. Completed minimum 70 precerts daily and coordinated with insurance carriers.
- Team leader for five pre-cert nurses.
- Completed a minimum of 70 precerts daily according to each hospital's requirements.
- Calculated the amount of each patient procedure needed and contacted the patient regarding payment information.
- Communicated with the nurse of each insurance carrier to get a procedure approved or denied according to the patients' qualifications.
- Pre-cert nurse for several hospitals located in Alabama, Texas, South Carolina, North Carolina and Kentucky.
LPN at BMC PRINCETON HOSPITAL, SELF NURSING HOME, CHILDREN'S MIDTOWN PEDIATRIC CLINIC, GENTIVA HOME HEALTH AND HOSPICE CARE (2003-08 – 2007-11)
Provided comprehensive nursing care to patients in home and institutional settings. Administered medications, wound care, medical procedures, and maintained detailed medical records.
- Provided nursing care to patients in their homes and in nursing institutions.
- Administered wound care, shots, meds, urinary catheters, ran EKG's, drew blood work, gave vaccine shots, inserted feeding tubes, charted files according to Medicare and Medicaid guidelines and started I.V.'s.
Senior Workers Compensation Examiner II at SEDGWICK CLAIMS MANAGEMENT, INC. (1997-11 – 2002-05)
Oversaw lost time workers' compensation claims from beginning to end. Coordinated with vendors, legal counsel, and insurance brokers while facilitating return-to-work processes.
- Oversaw lost time work comp claims from beginning to end.
- Coordinated with vendors, legal counsel, and insurance brokers daily.
- Assisted employees through the work comp process.
- Reviewed insurance policies to determine coverage.
- Prepared insurance claim forms or related documents and reviewed them to completion.
- Calculated the amount of insurance claims.
- Facilitated the return-to-work process.
- Maintained required OSHA requirements.
- Transmitted claims for payment or further investigations.
- Organized or worked with detailed office records.
- Posted and attached information to the claimant's file.
- And examined claims for the state of Alabama, Georgia, Tennessee, Arkansas and Kentucky.
