Jennifer Kaufman
Cicero
Summary
Versatile Registered Nurse with expertise in patient care, clinical audits, and fraud investigation. Demonstrates strong critical thinking and attention to detail across various healthcare settings, ensuring compliance and quality improvement. Adept at building relationships and providing educational support to patients, families and team members!
Overview
21
21
years of professional experience
1
1
Certification
Work History
RN: Clinical Outpatient Auditor
Cotiviti, Inc.
09.2024 - Current
- Execute post-service audits to verify coding accuracy and documentation for Medicare claims.
- Maintain productivity and quality goals with accuracy rates between 98-100%.
- Utilize critical thinking skills to assess clinical situations efficiently.
- Coordinate with additional team members and departments to ensure effective workflow.
RN: Mother-Baby Unit
St. Vincent Ascension Hospital
Carmel
09.2024 - 08.2025
- Provided patient care and monitored vital signs in critical care settings.
- Administered medications and documented responses in electronic health records.
- Educated patients and families on health management and post-discharge instructions.
- Provided emotional support and comfort to families during difficult times.
- Assisted in emergency situations, ensuring rapid response and patient safety.
- Participated in quality improvement initiatives to enhance patient care services.
- Utilized critical thinking skills to assess clinical situations quickly and accurately.
- Collaborated with physicians, nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
- Assessed, planned, implemented and evaluated nursing care for assigned patients.
- Maintained a safe environment for all patients by adhering to infection control policies and procedures.
RN: Clinical Fraud Investigator
Elevance Health
Indianapolis
12.2022 - 05.2024
- Conducted thorough reviews of claims and medical records to identify potential fraud, waste, and abuse.
- Participated in provider education and escalated investigations for case discussions.
- Maintained comprehensive knowledge of CMS policies and guidelines to ensure compliance.
- Utilized market-specific resources and company reimbursement policies for effective case analysis.
RN: Medical Management: Gov't Business Division
Elevance Health
Indianapolis
02.2019 - 12.2022
- Conducted investigations and reviews of appeals using medical necessity criteria and departmental guidelines.
- Demonstrated ability to work independently as well as collaboratively within a team environment.
- Demonstrated knowledge of current trends in nursing practices by attending continuing education classes or seminars.
- Resolved appeals and grievances promptly to ensure adherence to standards.
- Performed quality audits for associates, enhancing compliance with policies.
- Acted as a resource and mentor for new associates, fostering professional development.
RN: Medical and Utilization Review
Anthem/Elevance Health
Indianapolis
07.2012 - 02.2019
- Conducted pre-service reviews for inpatient and outpatient procedures using Anthem medical necessity criteria.
- Performed continued stay reviews for inpatient hospitalizations and advanced benefit determinations.
- Acted as liaison for peer-to-peer reviews, generating correspondence to providers and members.
- Resolved reviews promptly, ensuring compliance with regulatory time frames.
- Completed post-service claims review utilizing Anthem medical necessity criteria and federal policies.
RN
Indiana Surgery Center North
Indianapolis
11.2011 - 12.2012
- Provided direct patient care for pre-operative and post-operative surgical patients in ambulatory surgery center.
- Administered medications and managed IV therapies during post-operative recovery.
- Educated patients and families on post-operative care instructions to ensure smooth recovery.
- Accurately documented patient information in electronic health records systems to maintain compliance.
- Collaborated with additional team members such as physicians to ensure smooth operations of pre and post-operative.
- Assisted in maintaining a sterile environment throughout surgical procedures.
RN: Labor and Delivery/Postpartum
St. Francis Hospital
Indianapolis
08.2005 - 07.2012
- Provided direct patient care for labor and delivery, postpartum, and newborn nursery patients.
- Assessed, planned, implemented, and evaluated nursing care for assigned patients.
- Evaluated patients to identify complications and coordinated treatment with additional care team members.
- Monitored patient conditions, vital signs, recovery progress, and medication side effects.
- Advocated for patients by upholding fundamental rights, values, and beliefs.
- Prepared medical equipment and tools to aid physician during examination and treatment of patients.
- Adhered to infection control protocols to maintain a safe and hygienic environment.
- Trained and mentored new registered nurses on best practices and hospital policies.
Education
Bachelor of Science - Nursing (BSN)
Purdue Calumet University
Bachelor of Science - Safety Management
Indiana State University
Skills
- Regulatory compliance
- Compliance assurance
- Patient education
- Critical thinking and problem solving
- Attention to detail
- Time management
- Team collaboration
- Relationship building
Certification
- Registered Nurse, Indiana Compact (License #28153572C)
- Certified Professional Coder (CPC), 01874334
Timeline
RN: Clinical Outpatient Auditor
Cotiviti, Inc.
09.2024 - Current
RN: Mother-Baby Unit
St. Vincent Ascension Hospital
09.2024 - 08.2025
RN: Clinical Fraud Investigator
Elevance Health
12.2022 - 05.2024
RN: Medical Management: Gov't Business Division
Elevance Health
02.2019 - 12.2022
RN: Medical and Utilization Review
Anthem/Elevance Health
07.2012 - 02.2019
RN
Indiana Surgery Center North
11.2011 - 12.2012
RN: Labor and Delivery/Postpartum
St. Francis Hospital
08.2005 - 07.2012
Bachelor of Science - Nursing (BSN)
Purdue Calumet University
Bachelor of Science - Safety Management
Indiana State University