Nicole Cowen
Baton Rouge
Summary
Motivated, hard working, and reliable Registered Nurse with 7+ years of experience in acute care setting and currently working as a Denial Analyst. I recently obtained the Case Management Certification to enhance my knowledge and opportunities within my current role and the health system.
Overview
22
22
years of professional experience
Work History
Denial Analyst, RN
Franciscan Missionaries of Our Lady Health System
11.2022 - Current
- Analyze denied Inpatient medical claims to determine the root cause for denial in order to strategize the best course for resolution.
- Review medical records for clinical appropriateness of inpatient level of care to determine if appeal is warranted.
- Use clinical nursing judgement in conjunction with supporting medical records and documentation to formulate a structured and persuasive appeal to pursue Inpatient reimbursement.
- Work closely with Case Management at each facility to ensure continuity of the Utilization Management process; securing completeness of clinical documentation, level of care, and authorizations.
- Knowledge of Commercial/Medicare/Medicaid payor regulations and rules regarding authorizations, reimbursements, and appeal processes.
- Communicate with payors to resolve discrepancies and gain clarification.
- Proficient in using evidence based medical necessity screening tools, InterQual and MCG.
- Collaborate with Managed Care Contractors to ensure the appeal process is followed to completeness and for guidance with payor denials, reimbursements, and billing.
TRAUMA NEURO CRITICAL CARE (TNCC) REGISTERED NURSE
Our Lady of the Lake Regional Medical Center
06.2015 - 11.2022
- Provide direct quality care to patients following hospital protocols and standards
- Administration and monitoring of critical medications
- Ongoing collaboration and communication with other health care professionals to develop and alter treatment plans
- Serve as an advocate for the patient and their families
- Ability to critically think and prioritize patient care based on assessment data and identified needs
- Close monitoring and management of patient equipment/devices to determine potential complications and risks
- Assist physicians and staff with bedside procedures: endotracheal intubation, tracheostomy, bronchoscopy, central line placement, wound care, cardioversion
- Proficient at utilizing EPIC for reviewing patient data and documenting accurate and thorough patient care
NURSE INTERN II- MEDICAL/TELEMETRY UNIT
Baton Rouge General Medical Center
05.2014 - 05.2015
COMPUTER OPERATIONS SYSTEM OPERATOR
Air National Guard
12.2003 - 12.2009
- Performed duties as a Help Desk Technician, providing customer service and assistance to customers with network and account issues.
- Maintain accountability of users and equipment through Microsoft Active Directory.
- Install operating system and software on network computers.
Education
Bachelor of Science (B.S.) - Nursing
Franciscan Missionaries of Our Lady University
Baton Rouge, LA05.2015
Bachelor of Science (B.S.) - Management and Human Resources Management
Park University
Parkville, MO05.2009
Associate in Applied Science (A.A.S.) - Information Systems Technology
Community College of the Air Force
06.2008
Skills
- Certified Case Manager, Commission for Case Manager Certification (CCMC)- April 2025
- Basic Life Support
Timeline
Denial Analyst, RN
Franciscan Missionaries of Our Lady Health System
11.2022 - Current
TRAUMA NEURO CRITICAL CARE (TNCC) REGISTERED NURSE
Our Lady of the Lake Regional Medical Center
06.2015 - 11.2022
NURSE INTERN II- MEDICAL/TELEMETRY UNIT
Baton Rouge General Medical Center
05.2014 - 05.2015
COMPUTER OPERATIONS SYSTEM OPERATOR
Air National Guard
12.2003 - 12.2009
Bachelor of Science (B.S.) - Management and Human Resources Management
Park University
Associate in Applied Science (A.A.S.) - Information Systems Technology
Community College of the Air Force
Bachelor of Science (B.S.) - Nursing
Franciscan Missionaries of Our Lady University
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