Recovery Audit Review Consulting Company - Medical Chart Reviewer Resume Example

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Jaxon Turner
XXX XX XXXXXXX XXX, Denison, TX 75020
Professional Summary:

Goal-oriented Registered Nurse and  Medical Chart Reviewer with 24- year background in nursing and healthcare. Core competencies include case managementutilization review, concurrent inpatient review, and post-payment medical chart review as well as extensive experience in Medicare and Medicaid payment and documentation requirements. Performs documentation review with accuracy and efficiency.


Current Registered Nurse licensure in Texas.  Proficient in Microsoft Word and Excel.  Extensive experience and training in McKesson Interqual and Milliman Care Guidelines with effective utilization in determining medical necessity for inpatient admissions and outpatient services, in pre-payment, concurrent and post-payment methodologies.  Comprehensive experience in ICD-9 and CPT coding procedures, as well as recent completion in August 2015 of ICD-10 RN Boot Camp Coding Class. Experience with DRG and clinical validation methods. Plan for testing soon to obtain coding certifications. 

Medical Chart Reviewer Nov 2012Present Recovery Audit Review Consulting Company Frisco, TX Performing post-payment review for medical necessity and DRG validation for inpatient admissions and services.  Utilizing Milliman Care Guidelines, InterQual Guidelines, and nursing judgment to determine necessity for inpatient short stay versus observation admissions for Connolly clients.  Working in several different accounts, including Medicare, Aetna, UHC, Humana, and Amerigroup carriers. Using medical software programs and medical writing skills for nonrecoveries, as well as rationales for recoveries.  Also performing clinical validation review for DRG assignments.for inpatient stays.
Medical Audit Specialist Apr 2011Nov 2012 TrailBlazer Healthcare Denison, TX Performed post-payment review for medical necessity as part of TrailBlazer's contract with The Center for Medicaid and Medicare Services. Utilized various medical management software and writing skills for creation of detailed review and rationales for denials and resulting correspondence with Medicare providers.  Sadly had to leave this position when TrailBlazer lost the Medicare contract to another vender and the Denison facility was closed.
Medical Reviewer Mar 2010Aug 2010 Global Health Provider Network Oklahoma City, OK Utilizing chart review and nursing knowledge, analyzed hospital billing charges against medical documentation to determine accuracy in reporting for inpatient services. created detailed spreadsheets for all incorrectly reported procedures, medications, and DME charges accrued during inpatient hospital stays.  Had to leave this position due to relocation to Texas after divorce. 
Medical Review Audit Specialist May 2006Dec 2008 Oklahoma Health Care Authority Oklahoma City, OK Worked for the Oklahoma Health Care Authority, performing comprehensive medical chart review for medical necessity for outpatient services audits for the state's Medicaid certified providers.  Office visits, procedures, physical, occupational and mental health therapies were included in the sampling for these audits.  As part of a team, performed on-site comprehensive reviews across Oklahoma.  Resigned to care for my terminally-ill father, which required relocation to Texas for four months 
Nurse Review Specialist Nov 2005Mar 2006 Oklahoma Foundation for Medical Quality Oklahoma City, OK Worked as a medical chart review specialist as part of OFMQ's Medicaid contract with the state of Oklahoma.  Utilized InterQual criteria to determine medical necessity for services performed by Medicaid certified providers, including procedures and inpatient stays.  Had to leave to take a job with OHCA after OFMQ failed to secure renewal of their Medicaid contract with the state.
Telephonic Case Manager Apr 2005Oct 2005 CompChoice Oklahoma City, OK

Worked as a telephonic case manager, guiding worker's compensation patients through the healing process to ensure a timely progression to optimum health, productivity and return to work for CompChoice clients. Utilized worker's compensation-specific medical management programs, along with interpersonal skills, nursing knowledge and expertise.  Left this position to broaden experience in medical review at OFMQ.

Registered Nurse Health Care Finder Dec 1997Oct 2004 HealthNet Federal Services Tinker AFB, OK

Worked as a RN Health Care Finder for HealthNet as part of their contract with the TRICARE Military Health Program.  Proudly assisted military members and their families in obtaining quality health care by obtaining appointments and appropriate health care services, utilizing provider contacts, as well as medical and nursing knowledge.  Also performed pre-certification review and authorizations for requested services by military and TRICARE certified providers using appropriate InterQual review guidelines.  Left after 7 years when TRICARE awarded the contract to Humana and all nursing positions were moved to centralized locations. 

Registered Nurse May 1991Oct 1997 Integris Southwest Medical Center Oklahoma City, OK

Performed duties as a Registered Nurse on the cardiac step-down unit, medical-surgical floor, pediatrics and intensive care units.  Using the nursing care process, provided comprehensive care to patients during their hospitalization.  Worked closely with all members of the care team, included doctors, medication techs, LVN's, physical, respiratory and occupational therapists, and nursing aides to provide optimal and quality patient care. 

Associate of Science : Nursing May 1991 Oklahoma City College Oklahoma City, OK

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About this resume

Medical Chart Reviewer FROM Denison , Texas RESUME

This is a resume for a Medical Chart Reviewer in Denison, Texas with experience working for such companies as Recovery Audit Review Consulting Company and TrailBlazer Healthcare. The grade for this resume is 0 and is one of hundreds of Medical Chart Reviewer resumes available on our site for free. Use these resumes as templates to get help creating the best Medical Chart Reviewer resume.

School Attended
Oklahoma City College