Traci Humphrey
Manager, Clinical Denials & Appeals @Xsolis
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WORK HISTORY
Manager, Clinical Denials & Appeals @Xsolis
Franklin, TN, US
Manager, Clinical Denials & Appeals Department• Manages a team of (7) nurses and the workflow for appeals for inpatient medical necessity & DRG validation for multiple hospitals all over the United States• Senior UM/Appeals to ensure the timeliness of appeals worked and the assignment of cases.• Experienced in performing DRG Reconciliation processes. • Experienced with APR/MS-DRGs, PSI/HAC, and MCC/CCs.• Experienced in educating RNs, Physicians, CDI, and Leadership team members on process improvements for denial reduction.• Experienced in writing appeals letters from scratch.• Perform 2nd and 3rd Level, Concurrent, and Retrospective audits/reviews for Inpatient and Outpatient encounters. • Assist Physicians with Law Judge Hearings.• Work and communicate with private payers. • Interview, Hire, and train all new nurses, create workflows, and work with IT as the subject matter expert for product development.• Use proprietary case management software along with multiple hospital EMRs, including EPIC, Cerner, Meditech, MedHost, and ChartMaxx.
EDUCATION
Western Governors University
Bachelor of Science Nursing - Graduated BSN, Registered Nursing/Registered Nurse
Tennessee College of Applied Technology
Nursing
Western Governors University
Masters of Nursing - Currently Enrolled, Nursing Education
Excelsior University
Registered Nursing/Registered Nurse
ABOUT TRACI HUMPHREY
At the helm of XSOLIS\'s Clinical Denials & Appeals, my role capitalizes on a blend of…
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