Heather Guin
Clinical Reimbursement Specialist at QRM (Quality Rehab Management)
- Role
- Clinical Reimbursement Specialist at QRM
- Location
- Bossier City, LA, US
- LinkedIn followers
- 500 followers
About Heather Guin
PTA, RAC-CT, CRC- I am responsible for creating resources to educate our staff therapists, nurses, and customers on techniques for improved documentation, billing, and MDS/ICD-10 coding practices to prevent therapy and nursing-related denials and increase reimbursement under PDPM. I work to ensure compliance with Medicare and MAC rules/regulations by interpreting final rules, creating and presenting education, and notifying customers and staff members of any Congressional activity, updates, and advocacy related to Medicare. I also oversee the appeals for any of our customers’ denied Part A/B SNF and outpatient therapy denials by creating and submitting Redetermination and Reconsideration appeal letters and completing ALJ hearings. I oversee the tracking and managing of our company and customers\' denial statuses and liability amounts each month by creating extensive reports to determine success rates for closed and outstanding claims. I am RAC-CT certified and certified in Risk Adjustment Coding.
Experience
Clinical Reimbursement Specialist
Jul 2023 — Present
Education
Glenbrook School
High School Diploma
1996 — 2000
Bossier Parish Community College
Associates Degree of Science
2000 — 2003
Louisiana Tech University
Bachelors of Science
2004 — 2008
Skills
- Long Term Acute Care
- Allied Health
- Emr
- Hipaa
- Fall Prevention
- Rehab
- Utilization Management
- Patient Safety
- Healthcare Reimbursement
- Home Care
- Healthcare Management
- Inpatient
- Compliance Regulations
- Acute Care
- Cpr Certified
- Snf
- Revenue Cycle
- Quality Improvement
- Rehabilitation
- Long-Term Care
- Hospitals
- Healthcare
- Geriatric Rehabilitation
- Medicare/Medicaid Reimbursement
- Physician Relations
- Managed Care
- Clinical Development
- Patient Education
- Training
- Medical Terminology
- Process Improvement
- Wound Care
- Healthcare Industry
- Orthopedic
- Icd-9
- Physical Therapy
- Medical Compliance
- Medicare
- Practice Management
- Healthcare Consulting
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