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