I am a Registered Nurse with 10 years of progressive clinical experience and 5 years in medical virtual assistance, Quality Assurance, care coordination, and clinical auditing.
I am based in the Philippines and licensed in New York, Texas, and the Northern Mariana Islands (NMI), with strong expertise in CMS compliance, documentation accuracy, and audit readiness.
I am highly proficient in Axxess, Wellsky, eClinicalWorks, Humhealth, PointClickCare, MatrixCare, and consistently uphold HIPAA standards while supporting high-quality, compliant patient care.
Skills & Expertise:
-10 years of hospital nursing experience across medical-surgical wards and critical care units, with progression into senior and leadership roles within government healthcare settings.
-Skilled Chart Reviewer, Care Coordinator, and Clinical Auditor with in-depth expertise in Chronic Care Management (CCM), care planning, care coordination, and ongoing patient monitoring.
-Strong experience in prescription refill processing, appointment scheduling, and patient engagement, with the ability to track, report, and manage patient outcomes to improve care quality and meet reporting requirements.
-Home Health Quality Assurance expertise, including OASIS SOC, ROC, Recertification, Transfer, and Discharge reviews, regulatory compliance, ICD-10 coding validation, and identification of documentation gaps.
-Proven ability to collaborate with clinical teams, QA nurses, and compliance staff to support accurate billing, reimbursement, and audit readiness
Overwhelmed by these tasks?
>Prescription refill processing and medication coordination
>Appointment scheduling and patient outreach to improve engagement and continuity of care
>Development, review, and updating of patient-centered care plans (CCM, CoCM, and Hospice)
>Care coordination, remote patient monitoring, and follow-up to support long-term outcomes
>Tracking, analyzing, and reporting patient KPIs and clinical outcomes
>Home Health Quality Assurance, including OASIS SOC, ROC, Recertification, Transfer, and Discharge reviews
>CMS and regulatory compliance support across Home Health, CCM, Behavioral Health/CoCM
>ICD-10 coding validation, documentation accuracy checks, and discrepancy resolution
>Comprehensive chart reviews, clinical audits, and SPOT audits to ensure billing eligibility
>Close collaboration with providers, care managers, QA nurses, and compliance teams
>Documentation support to strengthen billing accuracy, reimbursement, and audit readiness
What I Can Do for You:
*Care Coordination & Patient Support
-Prescription Refills: Review refill requests, verify provider orders, coordinate with pharmacies, and ensure timely processing
-Appointment Scheduling: Manage calendars, confirm visits, reduce no-shows, and coordinate follow-ups across specialties
-Caregiver Scheduling & Assignment: Assign and schedule caregivers for hospital, facility, and home visits, ensuring proper coverage and continuity of care
-Patient Outreach & Engagement: Conduct follow-ups, reminders, and care coordination calls to support adherence and continuity of care
*Appointment Scheduling (with CCM focus)
-Schedule timely follow-ups, specialist referrals, and labs,
-Coordinate monthly CCM check-ins and annual wellness visits
*Care Planning & Chronic Care Management
-Develop and maintain person-centered care plans tailored to each patient's
physical, mental, and social health needs,
-Coordinate with providers to address medication management, preventive care,
and specialist referrals.
*Care Coordination
-Care Plan Development & Review: Create, update, and audit individualized care plans for CCM and CoCM, ensuring medical necessity and CMS compliance
-Care Coordination & Monitoring: Track patient progress, identify care gaps, escalate concerns appropriately, and support long-term outcomes
-Patient KPIs & Outcome Tracking: Monitor CCM time, clinical outcomes, utilization trends, and quality metrics to support reporting and quality improvement
*Ongoing Monitoring & KPI Tracking
-Track and report key performance indicators such as BP, weight, PHQ-9,
vaccination status, fall risk, and more.
*Quality Assurance & Clinical Auditing
-Home Health QA & OASIS Review: Review SOC, ROC, Recertification, Transfer, and Discharge OASIS assessments for accuracy and regulatory compliance
-Clinical Chart Reviews & Audits: Perform detailed chart audits for Home Health, CCM, Behavioral Health/CoCM, including SPOT audits
-Validate ICD-10 coding, functional scoring, and quality measures,
-Documentation Accuracy & Gap Resolution: Identify missing or inconsistent documentation and coordinate corrections with clinical teams
*Compliance, Coding & Billing Support
-Regulatory & CMS Compliance Support: Ensure documentation aligns with CMS guidelines, PDGM, HIPAA, and payer requirements
-ICD-10 Coding Validation: Review diagnoses for accuracy, linkage, and medical necessity to support compliant billing
-Billing & Reimbursement Support: Validate documentation and time logs to support clean claims and reduce denials
*Team Collaboration & Audit Readiness
-Clinical Team Collaboration: Work closely with providers, nurses, care managers, QA teams, and compliance officers
-Audit Readiness Support: Prepare records, resolve discrepancies, and maintain documentation standards for internal and external audits
Efficiently navigate these to to streamline workflows:
-Axxess
-Wellsky
-eClinicalWorks
-Humhealth
-PointClickCare
-GEHRIMED
-MatrixCare
Why Choose Me?
My professional background demonstrates my ability to elevate
your healthcare operations, reduce administrative burden, and ensure
compliance across all aspects of patient care. I am passionate about quality
improvement, accurate documentation, and seamless coordination,
and I pride myself on being dependable, detail-oriented, and fully committed to
every task.
"Hard work is the key to my success."
Let's work together to maintain high standards of care,
documentation accuracy, and operational excellence.
Talk soon, and more power!
-Tresha
