Terri Ward
Acworth,GA
Summary
Registered Nurse with extensive management and leadership experience in Hospice, Home Health, Geriatrics and Dialysis. CPC-A coding/billing certification with ICD-10 through AAPC and HCAFA fraud certification through AHIP.
Proficient in providing staff, family and patient education on an individual and group basis, and conflict resolution, mentoring, and team building.
Med-surg care, hemodialysis, pre-op and post-op outpatient procedure monitoring, venipuncture, and IV therapies including PICC use/removal, TPN, port-a-cath/medi-port, central lines.
Proficient with state, federal, and OSHA onsite surveys.
Overview
21
21
years of professional experience
Work History
Medical Review Lead, Nurse Auditor, RN, CPC, HCAFA
Qlarant
06.2020 - Current
- Provided expert guidance on coding practices and classification systems to enhance accuracy across all reviewed cases consistently.
- Supported timely claim processing by conducting thorough medical reviews and providing recommendations based on findings.
- Promoted a culture of continuous improvement by providing constructive feedback on documentation quality and clinical practices to healthcare providers.
- Maintained up-to-date knowledge of industry standards, regulations, policies, and procedures to ensure compliance throughout the review process.
- Developed and trained Medical Review Specialists on both internal processes and external regulations, while fostering a positive learning environment for all team members.
Claims Analyst Level II
Qlarant
05.2015 - 06.2020
- Perform post payment recovery medical review for hospice, non-citizen, and medical eligibility, providing detailed analysis of medical care for use in appeals processes
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records, following strict adherence and compliance with all HIPPA Laws
- Selected for pilot programs for new auditing appeals process, draft audit report processes, and potential SNF review.
- Mentored junior team members, sharing expertise in claims analysis techniques and fostering professional growth within the department.
Director of Nursing
Homestead Hospice
08.2012 - 04.2015
- Grew a 166 patient census to 200 as manager of the interdisciplinary team, QAPI Team Leader and Safety Officer.
- Responsible for office management, patient intake, clinical quality assurance, marketing and coordination of care with physicians, families, and patients, and working closely with administration to develop and implement best practices.
- Promoted three times within my first 2 years with the company.
- Assisted in establishing sister facility in Dalton, Ga with a deficiency-free state survey.
- Enhanced staff performance by conducting regular evaluations, providing constructive feedback, and offering tailored professional development opportunities.
- Oversaw and approved recruitment, hiring and orientation of new nursing staff.
Assistant Director of Nursing/RCC/MDS Coordinator
Blue Ridge Nursing Homes
04.2003 - 08.2012
- Provided case management utilizing MDS 3.0 in 120-bed facility.
- Administered thorough assessments including Medicare, Medicaid, and private insurance documentation, ICD-9 coding, and care plan development.
- Responsible for quality of care reviews with patient families and residents.
- ADON for 2 years, MDS Coordinator for 4 years.
Education
Bachelor of Science - Nursing
Aspen University
Denver, CO06.2022
Associate of Science - Nursing
Dalton State College
Dalton, GA06.1994
Skills
- Registered Nurse with extensive management experience in Hospice, Home Health, Geriatrics and Dialysis
- ACFE Certified Fraud Examiner
- CPC-A coding/billing certification with ICD-10 through AAPC and HCAFA fraud certification through AHIP
- Proficient in providing staff, family and patient education on an individual and group basis, and conflict resolution, mentoring, and team building
- Med-surg care, hemodialysis, pre-op and post-op outpatient procedure monitoring, venipuncture, and IV therapies including PICC use/removal, TPN, port-a-cath/medi-port, central lines
- Proficient with state, federal, and OSHA onsite surveys
- Case Management
- Medical Recordkeeping
- Performance Evaluation
- Conflict Resolution
- Effective Communication
- Medical Terminology
Timeline
Medical Review Lead, Nurse Auditor, RN, CPC, HCAFA
Qlarant
06.2020 - Current
Claims Analyst Level II
Qlarant
05.2015 - 06.2020
Director of Nursing
Homestead Hospice
08.2012 - 04.2015
Assistant Director of Nursing/RCC/MDS Coordinator
Blue Ridge Nursing Homes
04.2003 - 08.2012
Bachelor of Science - Nursing
Aspen University
Associate of Science - Nursing
Dalton State College
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