1.
Leigh A. Harrell
Joelton, TN 37080  615.598.4012  hairdo5137@comcast.net
ACHIEVEMENTS: ADMINISTRATIVEEXPERIENCE
 Coordinate admissions for state-wide private duty and community based
waiver home care company.
 Built strong professional relationships with partnering hospitals, case manager,
MCOs, and other related healthcare professionals, also provided
marketing/networking telephonically and on site with these providers.
 Resolve insurance, equipment, or level of care issues for existing patients.
 Coordinated start of service for pediatric therapy, intermittent homecare, and
infusion therapy services.
 Coding specialist for ICD-9/10, especially related to home care reimbursement
for Medicare, Medicaid and commercial insurance policies, and coding audits for
diagnosis appropriateness.
 Insurance verification, as well as, obtaining initial and concurrent authorization
for ordered services.
 Successful appealed denial of service based on medical guidelines against
Medicaid MCOs at a local and State level, as well as, commercial payor sources.
 Resolve insurance disputes and procured payment for services rendered from
the appropriate payor sources.
 Provided denial trending for 29 hospitals nationwide, reported directly for CFO
for each facility.
 Determined route causes for denials and worked directly with facility
employees and CFOs to define process improvements and assist in
implementing plans of improvement.
 Knowledgeable in MillimanCare Guidelines and InterQual Criteria for use in
acute care denials for reimbursement recovery.
 Trained acute care hospital case managers and staff regarding self-reporting
and denial prevention.
 Maintained State and Federal guidelines for medical practice in the State of
Tennessee.
 Supervised office support staff including secretarial, billing, and medical records
staff.
 Project coordinator for a Healthcare Consulting Firm and first assistant to the
President of the company.
 Controlled expenses and reimbursement reports for contracted consultants,
and coordinated all travel arrangements for consultants and clientele. Also
maintained strict deadlines for all contract consulting projects.
 Traveled to out of state locations and performed Medicare due diligence
surveys of several home health companies for prospective buyers.
 Managed the daily operation of an OB/GYN practice, including billing,
authorizations, and denial disputes.

2.
 Performed billing audits based on Medicare guidelines prior to billing of
authorized services.
 Dispute resolution by taking direct action whenever possible and follow up to
ensure dispute was resolved appropriately.
WRITING SKILLS:
 Composed letter of medical necessity for physicians
 Composed formal letters of appeal for denied services issued to MCOs, as well
as, State Medicaid
 Drafted and produced reports on findings on due diligence projects and
contracted home health audits
 Drafted and produced legally binding contracts for service for consulting
projects
 Modification, proofing, and production of purchased healthcare administration
manuals
 Designed new forms for use in a home health agency and acute care hospital
 Completed formal training in business writing
NURSING SKILLS:
 Cared for patients in acute, long term, hospice, mental health, substance abuse,
and physician office settings since 1993
 Correctional nursing, maximum security
 Performed maternal/fetal, STD, breastfeeding, and contraception education
 Grief support for patients and their families
 Scheduled and facilitated community flu shot clinics
 Clinical auditing based on state and federal guidelines
 Worked in state health agencies regarding high risk patients
 In-service training for skillednurses and home health aides
 Liaison between patient/family and managed care organizations
 Hospice care and support
 Tripled monthly private duty admission
 Streamlined admission process for private duty, pediatric therapy, and
community based waiver programs
 In-service/training peers on the use of McKesson Homecare Horizon and
ContinuLink software
 Manage admissions for Community and Homebased Waiver Services
 Home Care case management
 Conflict and dispute resolution peer and patient levels
COMPUTERSKILLS:
 ContinuLink Homecare super-user
 McKesson Homecare Horizon super-user
 Proficient in Microsoft Word, Microsoft Excel, Microsoft Outlook, Microsoft
PowerPoint, Microsoft Access, Picture It Publishing, Adobe Photoshop, Quick
Books
 Knowledgeable in Midas Case Management Software hospital based program
 Artiva, Meditech, Onbase(DEI), HOST, RCOM, ECIN proficient

3.
 DMS (denial maintenance system)
 Pulled complex reports from DMS for hospital insurance denial trending for 29
facilities nationwide
 Completed formal training in advanced ICD-9 and ICD-10 coding
 Re-designed company brochures and business cards
 Performed client billing using Microsoft QuickBooks for consulting firm
 Managed extensive company hard-drive
 Converted Word Perfect documents into readable Word Documents
 Organized files and folders into appropriate locations with the system network
EMPLOYMENT HISTORY:
 Licensed Practical Nurse
Nashville Metropolitan Bordeaux Hospital, Nashville, TN
7/1993 to 6/1994
 Licensed Practical Nurse
Intelistaf (no longer in business) prison staffing company
6/1994 to 8/1995
 Licensed Practical Nurse
State of Tennessee Department of Correction, Nashville, TN
8/1995 to 9/1999 again as PRN from 7/2000 to 8/2001
 Licensed Practical Nurse
Northcrest Medical Center, Springfield TN
1/2000 to 1/2002
 Licensed Practical Nurse
Springfield Children’s Clinic, Springfield, TN
2/2002 to 9/2002
 Office Manger
Dr. John O’Donnell, OB/GYN, Springfield, TN
9/2002 to 8/2005
 Enrolled full-time at NashvilleState Community College
10/2005 to 12/2005
 Performance Improvement, Interim Office Manager, Project Coordinator,
Clinical Auditor
Continuous Care Services/Healthcare Consultants, Nashville, TN
1/2006 to 2/2007
 Licensed Practice Nurse
Northcrest Medical Center, Springfield, TN
2/2007 to 12/2007
 State-wide Private Duty Intake Coordinator
Elk Valley Health Services, Nashville, TN
12/2007 to 8/2009
 Private Pay Homecare Marketer
Continuous Care Services, Nashville, TN
9/2009 to 10/2009
 Clinical Appeals Specialist
HCA Shared Services, Nashville, TN
11/1/2009 to 10/2010

4.
 State-wide Private Duty and Community Based Waiver Intake Coordinator
Elk Valley Health Services, Nashville, TN
11/2010 to Present
EDUCATION:
 Registered Nurse Bridge Program
Excelsior College, Albany, NY
Currently enrolled, completion in summer 2017
 Associate in Applied Science in Office Administration with a Healthcare
Concentration
Nashville State Community College, Nashville, TN
Graduated 2007 Cum Laude
 Licensed Practical Nurse
Nashville Metropolitan School of Practical Nursing
Received licensure through TN Board of Nursing in 1993
 Aquinas College, Nashville, TN
Course of Study: Ethics 1991
CHARITABLE AND COMMUNITYSERVICE:
 Softball Commissioner for Youth League and Board Member
Joelton Community Park
 Operation Christmas Child: Assisted with collection, production, and shipping of
Christmas Shoeboxes to underprivileged children around the world
 Lottie Moon Bake Sale: Bi-annual event to raise money for the Lottie Moon
Missionary Ministries