Connie McGregor

An experienced Medical Underwriting Professional, Registered Nurse and Risk Adjustment Coder seeks a full or part-time position with a leading organization. Proven record of planning, supporting, and managing care for patients in both remote and on-site roles. Fully trained, with an AAS degree in nursing, licensed RN, and Certified Professional Coder Certification (CPC).

Skilled in telephonic nursing, patient care oversight, medical underwriting, electronic records/files (EMR), risk management, clinical administration, and more. Diligent and goal-oriented, with the skills, education, and hands-on experience to make an immediate impact on any dynamic team.

Medicare Risk Adjustment (HCC) & Clinical Nurse Coder (CNC) - CSI Companies - Jacksonville, Florida

(2022-12 - 2026-04)

Clinical Nurse Coder (CNC) for the following programs: Advanced Pre-Visit Clinical Program (APCP) and Physician-Led Accurate & Complete Assessment Coding Program (PACC), included: Chart Review Clinical Suspecting (CRCS) and Prospective Enhanced Engagement (PROS). Performed Hierarchical Condition Category (HCC) coding and chart abstraction in alignment with CMS guidelines and Medicare Advantage Risk Adjustment models.

• Retrospective Coding: Medicare Chart Review (MCR); Affordable Care Act (ACA); Medicaid; First Time Coding (FTC); Open Suspect (OS): Second Level Review (SLR)
• Prospective Coding: In Office Assessment (IOA); Artificial Intelligence (AI) assisted coding; Escalations and more

Medical Information Specialist - Ashfield Healthcare - Fort Washington, PA

(2022-04 - 2022-12)

Exhibited effective communication and tele-management skills. Completely and accurately documented all Medical Information Requests, Adverse Events, and Product Quality Complaints in compliance with Ashfield, Client, and Federal guidelines and regulations. Collected demographic data and disposition for product, sample, and literature fulfillment.

Senior Medical Underwriting Analyst - Highmark Blue Cross Blue Shield - Parkersburg, WV

(2010-01 - 2021-09)

Risk Analysis of New, Pre-Screen, Ongoing and Renewal Members/Groups. Applied medical underwriting principles to Individual, Small and Large Group Medically Underwritten member applications. Reviewed attending physician's statements and medical/drug claims history. Utilized established guidelines to make rating decisions. Provided clinical judgement on diagnoses and future cost estimates regarding the impact of potential high claims to Stop-Loss Department.

Associate of Applied Science - Nursing (AAS); Registered Nurse (RN) - Excelsior College (2004-01 - 2006-01)