Debbie Coleman

Conducted pre-payment, post-payment, and Targeted Probe and Educate (TPE) reviews to ensure clinical compliance with Medicare rules and coverage guidelines. Analyzed UB claims and clinical documentation to identify improper billing, waste, and abuse, and provided education to mitigate denials.

Directed daily operations, resource allocation, and regulatory compliance for case management and discharge planning. Led performance improvement activities focused on workflow optimization, length of stay reduction, and patient throughput, and headed the denial management program.

Managed daily operations of the Discharge Planning Team, Resource/Utilization Case Managers, and Clinical Documentation Specialists. Collaborated with executive leadership to implement operational plans, managed recruitment and staff development, and aligned policies with TJC and government mandates.

Reviewed medical charts, audited quality of care metrics, and managed clinical updates for third-party payers.

Formulated targeted training to decrease surgical infection rates and reported core measurement compliance data directly to The Joint Commission.

Delivered direct, high-quality clinical care to surgical patients in a fast-paced acute care environment.

Bachelor of Science in Health Sciences from California College for Health Sciences.

Associate of Science in Nursing from Palm Beach Community College.

Registered Nurse (RN) licensure from the State of Florida.

Accredited Case Manager (ACM) certification from the American Case Management Association.