Monique Poole
DeQuincy
Summary
Seasoned Registered Nurse of 26 years with over 14 years in home health leadership and appeals, utilizing data analysis and regulatory compliance to minimize denials and expedite resolutions. Skilled in customer advocacy, process improvement, and cross-functional coordination, aligning clinical, billing, and legal stakeholders to enhance appeal outcomes. Committed to implementing evidence-based workflows and checklists to improve reviewer consistency and optimize patient access to services.
Overview
14
14
years of professional experience
Work History
SENIOR GRIEVANCES & APPEALS PROFESSIONAL
Centerwell Homehealth
Remote
03.2021 - 02.2026
- Audit denied claims to identify recurring documentation gaps, implemented targeted corrections and training, yielding noticeable reductions in repeat denials.
- Proficient in PDGM and HHRGs related to Home Health Billing and payment.
- Expertise in auditing and review of medical records
- Knowledge and use of Medicare regulations protocols and policies
- Analyzed, researched and wrote appeals for level One and level Two claims
- Performs meticulous evidence verification and chronology assembly for each appeal, strengthening submission completeness and readiness for external audits.
- Skilled at working independently and collaboratively in a team environment.
- Excellent communication skills, both verbal and written.
- Managed time efficiently in order to complete all tasks within deadlines.
- Used critical thinking to break down problems, evaluate solutions, and make decisions.
- Learned and adapted quickly to new technology and software applications.
- Proved successful working within tight deadlines and a fast-paced environment.
- Developed and maintained courteous and effective working relationships.
- Facilitates cross-functional meetings between clinicians, billing and legal to reconcile evidence and align next steps, ensuring coherent responses to complex appeals.
- Institutes prioritized review lanes for urgent member cases to expedite resolution, improving timeliness of beneficiary reimbursements and service continuity.
- Establishes standardized decision criteria and documentation checklists to improve reviewer consistency and uphold regulatory compliance across cases.
- Self-motivated, with a strong sense of personal responsibility.
HOME HEALTH ADMINISTRATOR
Allegiance Home Health
DeQuincy, USA
07.2019 - 04.2021
- I was acting Administrator and Director of Nursing in August 2019 when Allegiance Home Health purchased DeQuincy Home Health.
HOME HEALTH ADMINISTRATOR AND DIRECTOR OF NURSES
DeQuincy Home Health
DeQuincy, La
03.2012 - 07.2019
- Audited patient outcome patterns to pinpoint common readmission drivers, then launched targeted care pathways that produced noticeable reductions in repeat hospital visits.
- Implemented clinician scheduling redesign to balance caseloads and reduce missed visits, improving continuity of care and staff workflow efficiency.
- Implemented procedures and home-safety assessments, strengthening patient safety and increasing clinician confidence during home visits.
- Joined DeQuincy Home Health in 2012 as Field Nurse, providing patient care; transitioned to scheduling all disciplines for patient visits, then promoted to Director of Nurses and later added Administrator responsibilities.
Education
ADN - Lake Charles
Mcneese State University
Lake Charles07-2000
Skills
- Claims management
- Regulatory compliance
- Healthcare regulations
- Process improvement
- Customer advocacy
- Data entry
- Conflict resolution
- Analytical thinking
- Time management and organization
- Teamwork and collaboration
Languages
English
Native or Bilingual
Timeline
SENIOR GRIEVANCES & APPEALS PROFESSIONAL
Centerwell Homehealth
03.2021 - 02.2026
HOME HEALTH ADMINISTRATOR
Allegiance Home Health
07.2019 - 04.2021
HOME HEALTH ADMINISTRATOR AND DIRECTOR OF NURSES
DeQuincy Home Health
03.2012 - 07.2019
ADN - Lake Charles
Mcneese State University
Additional Information - Summary Of Experience
- Audit denied claims to identify recurring documentation gaps, implements targeted corrections and training, yielding noticeable reductions in repeat denials.
- Facilitates cross-functional meetings between clinicians, billing and legal to reconcile evidence and align next steps, ensuring coherent responses to complex appeals.
- Institutes prioritized review lanes for urgent member cases to expedite resolution, improving timeliness of beneficiary reimbursements and service continuity.
- Performs meticulous evidence verification and chronology assembly for each appeal, strengthening submission completeness and readiness for external audits.
- Establishes standardized decision criteria and documentation checklists to improve reviewer consistency and uphold regulatory compliance across cases.
- Implemented clinician scheduling redesign to balance caseloads and reduce missed visits, improving continuity of care and staff workflow efficiency.
- Audited patient outcome patterns to pinpoint common readmission drivers, then launched targeted care pathways that produced noticeable reductions in repeat hospital visits.
- Implemented procedures and home-safety assessments, strengthening patient safety and increasing clinician confidence during home visits.
- Started with DeQuincy Home Health in 2012 as a Field Nurse seeing patients, during my time with DeQuincy I also worked in scheduling in which I scheduled all disciplines for the patient visits. Then due to personnel changes I was asked to take the Director of Nurses position and then administrator was added to my list of duties.