Susan Cobb
Monroe
Summary
Registered Nurse with a proven track record at Center Well Home Health, excelling in regulatory compliance and denial management. Utilizing proactive problem-solving, I enhance clinical operations through data-driven reporting and collaborative teamwork, driving quality improvement initiatives that enhance patient care standards.
Overview
10
10
years of professional experience
Work History
Registered Nurse
Center Well Home Health
Plano
01.2016 - Current
- Identifies the need for changes in policies, procedures, documentation strategies, and protocols based on regulatory requirements, and makes recommendations as indicated.
- Responsible for responding to, managing and monitoring all payer requests for additional documentation, appeals, and denials.
- Monitors denials, collaborates with branch and billing staff to determine appropriate response, manages appeals process.
- Responsible for constructing response to denials in appeals, utilizing any federal guidelines or local coverage determination guidelines that are applicable to the record and response.
- Monitors the development, interpretation, and implementation of federal and governmental regulations. Coordinate the dissemination of information.
- Provides trended reports for operations and clinical management in order to improve performance, collaborates with and acts as a resource for division and field support staff in identifying areas in need of attention/improvement.
- Identifies the need for new and revised policies and training based on trends, changes and regulations, operations or clinical programs.
- Participates in project team activities, and serves as a back up to divisional regulatory staff on issues of regulations, coverage, compliance and documentation.
- Reviews records and operations as requested, regarding compliance with policy and payer requirements.
- Participates in and provides training as assigned.
Education
Associate of Applied Science - Nursing
Baptist Health School of Nursing
Little Rock, AR12-2004
Skills
- Regulatory compliance
- Denial management
- Payer communication
- Quality improvement
- Collaborative teamwork
- Training development
- Data collection
- Reporting and documentation
- Regulatory interpretation
- Documentation strategies
- Clinical compliance
- Microsoft Outlook, Word, and Excel
- PowerPoint
References
References available upon request.
Timeline
Registered Nurse
Center Well Home Health
01.2016 - Current
Associate of Applied Science - Nursing
Baptist Health School of Nursing
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