Jennifer Warren

• Conduct thorough reviews of billed services, authorizations, and medical records to support strategic goals.
• Make reimbursement recommendations based on coding accuracy, billing statistics, and compliance standards.
• Review, complete, track, and audit complex cases and high dollar claims following internal guidelines.
• Recommend necessary process improvements and forward as appropriate, any cases for Quality review.
• Provide data and expertise to Leaders and/or other departments of the Health Plan on Medical Policy and Appeals as necessary.
• Develop, review, and revise training materials, policies and electronic references to assure training for new and existing staff is consistent.
• Monitor provider claim edit issues and communicate concerns for resolution.
• Work with vendors to ensure cost-effectiveness and compliance.
• Develop and maintain internal department logs for accurate reporting of claim review volume, savings, staff development, and trending.

Case Manager, LPN-03/2009 to 06/2013-Geisinger Bloomsburg Hospital

Clinical Access Specialist, LPN- 06/2013 to 05/2017 -Geisinger Medical Center

• Reviewed high-volume patient case load to assess medical necessity using nursing expertise and Interqual criteria.
• Led team meetings to coordinate patient care and optimize workflow.
• Facilitated communication between departments to enhance service delivery.
• Trained new staff on operational procedures and best practices.