Daneshea Crews

About Daneshea Crews

Audit and Oversight: Extensive knowledge with Compliance Auditing, Revenue Cycle…

Experience

1. Utilization Management Clinical Appeals Rn

   Piedmont

   Mar 2017 — Present

   Developed processes/procedures for centralized clinical appeals department for 19 hospital healthcare system • Lead Trainer/Educator for Clinical Appeals nurses, responsible for orienting new hires, educating new hires on appeals process, denials management, department policies and procedures • Department resource for Clinical Appeals staff assisting with appeals defense, billing/coding issues with denied claims • Department Liaison for all Clinical Appeals (Commercial, Government) to Management, consulting concerns, templates, and streamline EPIC workflow for Clinical Appeals • Collaborates with Technical denials management team to resolve claim denial issues • Recovery of revenue associated with disputed/denied clinical claims or those eligible for clinical review • Retrospective Review of denied claims to determine reasons and processes needed to resolve denied claims • Utilize current knowledge base of medical coding, federal and state hospital Utilization Review (\"UR\") regulations and Medicare guidelines regarding medical necessity, inpatient, outpatient and observation status to draft effective narratives for Medicare, Medicaid, and Commercial Insurance appeals • Effectively combine documentation to defend denied claims including medical records, appeal letter, policies, regulations and medical research • Works with payers both on the phone and through electronic means to resolve denials and receive payment on denied claims • Track denied, appealed and rebilled claims to ensure revenue recovery or resolution of denied claims • Collaborate with other departments to resolve denials; including rebilling of claims, ensuring corrected claims are submitted, physician medical necessity letters, claim write offs

Skills

• Medicaid
• Inpatient
• Emergency Room
• Interqual
• Respiratory Therapy
• Meditech
• Recovery Audit
• Medicare
• Nursing
• Ccu
• Healthcare
• Clinical Documentation Improvement
• Acls
• Medication Administration
• Respiratory Care
• Patient Advocacy
• Bcls
• Medical Billing
• Jcaho
• Medical Coding
• Patient Education
• Mac Audits
• Cms
• Acute Care
• Medical Records
• Patient Safety
• Ekg
• Emr
• Ventilators
• Compliance
• Epic Systems
• Hipaa
• Critical Care
• Healthcare Management
• Auditing
• Hospitals
• Icd-9
• Bls
• Intensive Care
• Mechanical Ventilation