Stacy Crocker RN
Cumming
Summary
Dynamic and detail-oriented professional transitioning into the role of Clinical Denial Specialist, equipped with a robust foundation in analytical skills, problem-solving, and critical thinking. Expertise in communication and negotiation complements a comprehensive understanding of insurance processes. Committed to enhancing claim resolution efficiency, reducing denials, and securing accurate and timely reimbursements within healthcare environments. Passionate about driving improvements in operational workflows to support financial sustainability and patient satisfaction.
Overview
27
27
years of professional experience
Work History
Care Coordinator/Utilization Review RN
Northside Forsyth Hospital
03.2016 - Current
- Compiling daily clinical utilization reviews to support the need for hospitalization. Communicating with insurance companies to obtain authorization for hospitalization stays and for post-acute services. Conducting comprehensive reviews of denied claims, to resolve disputes and ensure timely reimbursement. Participating in Interdisciplinary Team meetings to facilitate the delivery of consistent quality health care services and providing appropriate resources and assistance to patients with regards to managing their health care. Proficiency in EMR, Careport, Cerner, Interqual, Microsoft Suite, One Content software programs. Assisting patients and their families with discharge planning to provide a safe discharge from the hospital. Arranging post-acute services such as hospice, rehab, HHC, DME, infusion, housing, obtaining prior authorization for medications. Obtaining clinical and financial information to assist patients in applying for financial assistance.
RN Charge Nurse/Case Manager/Hospital Liaison
Embracing Hospice Inpatient Unit
03.2008 - 02.2016
- Case manager for hospice patients in an inpatient unit, which includes: performing patient assessments, coordinating plan of care with the Interdisciplinary team, assisting with discharges to home and facilities, educating patients and families on disease process/hospice philosophy and signs/symptoms of dying process, completing admissions, electronic medical records, assisting the physician in bedside procedures, charge nurse responsibilities, obtaining consents, administering medications and IV fluids, catheterizations, wound care, medication reconciliation, computer charting on Allscripts.
Back Office Nurse
Dr. Jack B Potter, Internal Medicine, Allergy & Immunology
06.2005 - 12.2007
- Performed assessments, venipuncture, x-rays, administered injections, answered phones, insurance verification, performed EKGs, electronic charting.
RN, Floor Nurse
Children’s Healthcare of Atlanta
09.2000 - 04.2001
- Worked on the respiratory floor, performed patient assessments, administered medications, IV fluids, wound care, patient/family education, computer charting, venipuncture.
Office Nurse
Children’s Medical Group
10.1998 - 04.2000
- Performed height/weight checks, phone triage, took vital signs, administered vaccinations and medications, nebulizer treatments, hearing/vision screenings, patient/parent education on growth/development and diseases, catheterizations, venipuncture, verification of benefits, referrals, computer charting, follow up care of patients.
Education
Associate of Science - Nursing
University of North Georgia
Dahlonega, GA06-1998
Skills
- Proficient in Microsoft Office Suite, Cerner, Interqual, EMR
- Collaborates and communicates efficiently with Interdisciplinary teams
- Utilizes clinical documentation to support inpatient necessity
- Knowledge of payer guidelines and policies
- Healthcare compliance and regulations
Timeline
Care Coordinator/Utilization Review RN
Northside Forsyth Hospital
03.2016 - Current
RN Charge Nurse/Case Manager/Hospital Liaison
Embracing Hospice Inpatient Unit
03.2008 - 02.2016
Back Office Nurse
Dr. Jack B Potter, Internal Medicine, Allergy & Immunology
06.2005 - 12.2007
RN, Floor Nurse
Children’s Healthcare of Atlanta
09.2000 - 04.2001
Office Nurse
Children’s Medical Group
10.1998 - 04.2000
Associate of Science - Nursing
University of North Georgia
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