Brenda Tibbs
Nashville,TN
Overview
27
27
years of professional experience
Work History
Medical Review Specialist
CGS Administrators
07.2021 - 07.2024
- Affirm procedures per CMS guidelines for panniculectomy, Botox cervical fusion, facet injections, blepharoplasty, rhinoplasty, and spinal cord stimulators
Certified Medical Coder
Cigna Insurance Companies
12.2019 - 07.2021
- Worked at Cigna in various positions on a temp basis.
- Worked as Case Manager and coder until COVID
Telephonic Triage
HCA Healthcare
09.2017 - 11.2019
- Worked remotely receiving triage call. Triage medical, surgical, pediatrics, mental health, OB, and general medical triage calls
Documentation Specialist
Saint Thomas Midtown Saint Thomas Health
10.2007 - 12.2017
- Abstraction Core Measures Pneumonia, Congestive Heart Failure, Acute Myocardial Infarction, Stroke. Outpatient Measures Colonoscopies VTE OP 33 OP 29 OP30 Immunization Tobacco Treatment ED and Throughput
- Experience with abstraction of PCI, STS, and Get With the Guideline Stroke data
- Abstracting HBIPs data for Ascension
- Currently abstracting for Vascular Quality Initiative Carotid Stent and Endarterectomies.
- Developed Vascular Quality Initiative Abstraction for System.
- Data Manager for Vascular Registry for Ascension.
- Duties include entering demographic data, procedure, medical history, and Follow up with the patient 8-12 months post-procedure.
- Interact with Coding and Physicians to improve documentation.
- Submit Vascular Data to CMS.
- Act as Resource for Physicians, Nurses, and other stakeholders for VQI
Case Manager
Select Speciality
10.2004 - 10.2007
- Demonstrates compliance with facility-wide Utilization Management policies and procedures, specific to the responsibilities held by the Case Management Department.
- Coordinates UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
- Facilitates effective, open communication between staff and the case manager.
- Demonstrate and responsiveness to employee issues, and resolve situation effectively and in a timely manner.
- Assures department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient.
- Works cooperatively as a team member to identify and solve facility-wide needs and improve operation.
Regional Nurse
State of Tennessee
06.2003 - 09.2004
- Work with agencies regarding the oversight of medical care of persons with mental retardation who live in the community.
- This included the framework assessments, interventions, evaluation of Gout nuous and comprehensive health-related standards of community development and nursing practice.
- The medical care implementation, documentation, and evaluation.
- Included in the assessment are risk factors related to family dynamics, environment, economic, legal, and culture that may affect the person’s health.
- Facilitated Utilization Management process for inpatient and outpatient services, ancillary and referral services.
- Implemented necessary services that provided quality care in a cost-efficient manager.
Nurse Case Manager
Protegrity Humana
07.2000 - 07.2000
- Managed resources and flexible cost cost-effective options for catastrophically injured workers.
- Facilitated quality individualized treatment goals and set up communication and coordination between all members of the healthcare team.
- Involved patient and family in decision-making process in order to minimize fragmentation of healthcare delivery system.
Nurse Case Manager
Intra
01.2000 - 05.2000
- Provided resources and flexible cost cost-effective options for catastrophically injured workers.
- Established quality individualized treatment goals.
- Enabled communication and coordination between all members of healthcare team.
- Involved patient and family in decision-making process in order to minimize fragmentation of the health care delivery
Telephone Nurse Case Manager, Workers Compensation
CNA Insurance
01.1998 - 01.2000
- Managed resources and flexible cost cost-effective options for catastrophically injured workers.
- Facilitated quality individualized treatment goals and set up communication and coordination between all members of the healthcare team.
- Involved patient and family in decision-making process in order to minimize fragmentation of healthcare delivery system.
Telephone Nurse Case Manager
Travelers Property Casualty Corp
12.1997 - 12.1998
- Provided resources and flexible, cost-effective options for catastrophically injured workers.
- Established quality individualized treatment goals.
- Enabled communication and coordination between all members of healthcare team.
- Involved patient and family in decision-making process in order to minimize fragmentation of the healthcare delivery system.
Education
Bachelor of Science - Psychology and Sociology
Tennessee State University
Nashville, TN01.1970
Skills
- Certified Nurse Case Manager
- Documentation
- Quality Assurance/Review
- Managed Care
- Medical Research Data Abstraction
- Chart Abstraction
- Medical Records
- EMR Systems
- Appeals & Denials
- Grievances
- Software: Midas,Cerner,GWTG, 3M360, and PATs
- Currently entering data in Pathways, Premier, and using Excel Spreadsheet to submit to CMS
- Good Communications Skills
- Microsoft Office Suite
- Interqual
- Milliman
- Utilization Review
- Discharge Planning
- ICD 9, ICD 10
- Disease Management
LANGUAGES
English
SOCIAL NETWORKS
Linkedin, www.linkedin.com/in/brenda-tibbs-0802b9345
Timeline
Medical Review Specialist
CGS Administrators
07.2021 - 07.2024
Certified Medical Coder
Cigna Insurance Companies
12.2019 - 07.2021
Telephonic Triage
HCA Healthcare
09.2017 - 11.2019
Documentation Specialist
Saint Thomas Midtown Saint Thomas Health
10.2007 - 12.2017
Case Manager
Select Speciality
10.2004 - 10.2007
Regional Nurse
State of Tennessee
06.2003 - 09.2004
Nurse Case Manager
Protegrity Humana
07.2000 - 07.2000
Nurse Case Manager
Intra
01.2000 - 05.2000
Telephone Nurse Case Manager, Workers Compensation
CNA Insurance
01.1998 - 01.2000
Telephone Nurse Case Manager
Travelers Property Casualty Corp
12.1997 - 12.1998
Bachelor of Science - Psychology and Sociology
Tennessee State University
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