Wendy Muse
Ponchatoula
Summary
Medical Bill Review Nurse with expertise in clinical auditing and documentation review at Sedgwick Claims Management. Proven track record in enhancing billing accuracy and compliance through meticulous audits. Strong critical thinking and teamwork skills. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
2027
2027
years of professional experience
Work History
Nurse Auditor
Sedgwick Claims Management/York Risk Services
REMOTE
10.2014 - Current
- Led audits of medical claims to ensure compliance with regulations and company policies.
- Reviewed clinical documentation for accuracy and completeness, improving claim processing efficiency.
- Reviewed coding practices for consistency and accuracy, promoting appropriate reimbursement levels for services provided.
- Improved billing accuracy by conducting thorough medical record audits and identifying discrepancies in documentation.
- Managed audit-related projects with tight deadlines, consistently delivering high-quality results on time and within budget.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Verified accuracy of patient information in medical records.
Home Health Registered Nurse Case Manager
Key Home Health Care
Hammond, LA
2006 - 2014
- Coordinated patient care plans with interdisciplinary teams to optimize health outcomes.
- Conducted comprehensive assessments to identify patient needs and develop tailored interventions.
- Monitored patient progress, adjusted care plans as necessary, and documented findings accurately.
- Educated patients and families on disease management and self-care techniques for improved health literacy.
- Introduced changes to patient care plans based on regular evaluations and patient changes.
- Prevented complications by promptly identifying potential issues and taking appropriate action to address them.
- Administered medications and treatments as prescribed by physicians.
- Monitored vital signs, developed and implemented care plans, and documented patient progress.
Home Health Registered Nurse
Primecare Network
Hammond, LA
2004 - 2006
- Provided comprehensive patient assessments and developed individualized care plans to enhance health outcomes.
- Administered medications and treatments according to physician orders, ensuring adherence to safety protocols.
- Educated patients and families on disease management, promoting self-care and improving understanding of health conditions.
- Collaborated with multidisciplinary teams to coordinate patient care, enhancing communication and service delivery efficiency.
Registered Nurse
Fresenius Kidney Care Dialysis
Baton Rouge, LA
1996 - 2003
- Administered comprehensive patient assessments to develop individualized care plans.
- Monitored vital signs and clinical data to ensure patient safety and comfort.
- Collaborated with interdisciplinary teams to optimize treatment protocols and enhance patient outcomes.
- Educated patients and families on dialysis processes, fostering understanding and compliance.
- Promoted a positive work environment through effective teamwork, open communication, and strong leadership skills.
- Coordinated daily shift assignments to ensure adequate staffing levels for optimal patient care delivery.
- Collaborated with physicians to develop individualized care plans addressing each patient''s unique needs and goals.
- Administered medications and treatments to manage patient's condition.
Education
Bachelor of Science - Nursing
Southeastern Louisiana University
Hammond, LASkills
- HIPAA regulations
- Critical thinking
- Documentation review expertise
- Electronic health records navigation
- Regulatory guidelines adherence
- Clinical auditing expertise
- Teamwork and collaboration
- Time management
- Attention to detail
- Multitasking Abilities
- Reliability
- Adaptability and flexibility
- Claims processing
Timeline
Nurse Auditor
Sedgwick Claims Management/York Risk Services
10.2014 - Current
Home Health Registered Nurse Case Manager
Key Home Health Care
2006 - 2014
Home Health Registered Nurse
Primecare Network
2004 - 2006
Registered Nurse
Fresenius Kidney Care Dialysis
1996 - 2003
Bachelor of Science - Nursing
Southeastern Louisiana University