The document provides a summary of Leigh A. Harrell's administrative experience, achievements, skills, and employment history. It outlines her experience coordinating admissions and resolving issues for patients in home care, as well as coding, insurance verification, and appeals. Additionally, it details her nursing experience since 1993 in various settings, computer skills in software like ContinuLink and Microsoft Office, and education including an Associate's degree from Nashville State Community College.

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