Anna Hawkins, RNC-NIC
Knoxville,TN
Summary
Certified Neonatal Intensive Care Nurse with 20+ years experience specializing in Neonatal Intensive Care Nursing in a level III NICU. Experience includes advanced training in intubation and central line placement, transport, and delivery attendance.
Transition to Clinical Validation Auditing in 2019, applying extensive knowledge and clinical background in Neonatal and Obstetric nursing to ensure documented diagnoses are clinically valid. Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns.
Overview
26
26
years of professional experience
1
1
Certification
Work History
DRG Clinical Validation Auditor
Elevance Health
09.2021 - Current
- Program Integrity - Complex & Clinical Audit
- Responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializing in review of Diagnosis Related Group (DRG) paid claims. Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions. Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmission, inpatient admission status, and Hospital-Acquired Conditions (HACs).
- Quality Assurance Auditor: Identify audit inconsistencies, auditor educational needs, quality gaps, and ensures coding and clinical audits are performed applying the appropriate coding guidelines and/or clinical criteria.
Clinical Validation Auditor
Change Healthcare
09.2019 - 09.2021
- Perform Clinical Validation Audits and appeals on neonatal claims by applying extensive knowledge of clinical criteria and guidelines accurately and objectively while maintaining productivity targets.
Registered Nurse
East Tennessee Children's Hospital - NICU, Level III
06.1999 - 09.2019
- Primary care, assessment and evaluation of neonatal patients.
- Charge nurse - NICU, level III, 60 bed unit.
- Neonatal Transport Team (Children's Lifeline ambulance, traveling throughout East TN)
- Neonatal Nurse Clinician (Nurse only transports and attends deliveries in local hospital)
- Certified Neonatal Intensive Care Nurse.
Education
Associate of Science - Formerly Fort Sanders School of Nursing
Tennessee Wesleyan College
Knoxville, TN05.1999
Skills
- Ability to perform in-depth analysis of clinical documentation relating to diagnoses
- Perform screening of MS-DRG and APR DRG claims to evaluate for potential claim errors and apply selection criteria for audit
- Ability to use software, hardware, and peripherals related to job responsibilities, including MS office
- Excellent spoken and written communication skills
- Excellent analytic, organizational, and prioritization skills
- Ability to multi-task in fast-paced environment
- Ability to be decisive and work independently
- Proficient in multiple electronic medical records systems
- Ability to research clinical criteria and evaluate for accuracy
- Perform appeal reviews and responses
- Quality Assurance
- Strong clinical judgement
- High level of autonomy
- Patient/family focused
Certification
- Certified Neonatal Intensive Care Nurse, NCC ID:104379316
- ACDIS Clinical Documentation Integrity Boot Camp - completed 5/2021 *covered ACDIS-endorsed best practices for medical record review and compliant physician querying.
Timeline
DRG Clinical Validation Auditor
Elevance Health
09.2021 - Current
Clinical Validation Auditor
Change Healthcare
09.2019 - 09.2021
Registered Nurse
East Tennessee Children's Hospital - NICU, Level III
06.1999 - 09.2019
Associate of Science - Formerly Fort Sanders School of Nursing
Tennessee Wesleyan College
- Certified Neonatal Intensive Care Nurse, NCC ID:104379316
- ACDIS Clinical Documentation Integrity Boot Camp - completed 5/2021 *covered ACDIS-endorsed best practices for medical record review and compliant physician querying.
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