Layken Adams

Registered Nurse with 11 years of nursing experience and nearly five years of remote medical review experience. Skilled in reviewing medical records for medical necessity and compliance with CMS and Medicare coverage requirements, researching and applying LCDs, NCDs, CMS manuals, and regulatory guidance, and educating providers on documentation requirements. Experienced in independently managing high-volume review work while meeting established productivity, quality, and timeliness standards.

Registered Nurse | Medical Review at Avosys Technology (Subcontract) (2021-11 – Present)

• Perform medical record reviews to evaluate clinical documentation for compliance with CMS requirements, applicable Medicare coverage policies, and medical necessity guidelines.
• Research and apply current Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), CMS manuals, and regulatory guidance to support accurate review determinations.
• Coordinate medical review activities for 20+ providers while maintaining required CMS timeliness standards and independently managing a high-volume remote workload.
• Communicate documentation findings and provide education and guidance to healthcare providers regarding Medicare coverage requirements and evolving regulatory expectations.
• Consistently meet established productivity and quality standards while maintaining accuracy and attention to regulatory compliance.

Registered Nurse | Medical-Surgical Unit at Clinch Valley Health (2015-11 – 2018-02)

• Provided comprehensive nursing care in a fast-paced medical-surgical setting, with cross-training in skilled nursing and emergency care.
• Served as Charge Nurse, coordinating patient care, prioritizing clinical needs, and supporting nursing staff throughout the shift.
• Performed comprehensive patient assessments and collaborated with physicians and interdisciplinary teams to coordinate individualized plans of care.

Registered Nurse | Medical-Surgical Unit at Clinch Valley Health (2019-11 – 2021-10)

Registered Nurse | Home Health & Hospice at MSA Home Health & Hospice (2018-02 – 2019-10)

• Initiated plans of care and collaborated with physicians, patients, families, and interdisciplinary team members.
• Reviewed and audited clinical documentation for accuracy and compliance with Medicare and Medicaid requirements.
• Coordinated physician orders, patient scheduling, and supervisory visits for CNAs and LPNs.

Bachelor of Science in Nursing in Nursing – King University (2017)

Associate of Applied Science in Nursing in Nursing – Southwest Virginia Community College (2015)