Suzanne Woodings
@suzannewoodings
Experienced healthcare manager specializing in clinical appeals and revenue optimization.
What I'm looking for
I am a dedicated healthcare professional with a diverse background in law, nursing, and business administration. With a Doctor of Law and a Bachelor of Science in Nursing, I have cultivated a unique skill set that allows me to navigate complex clinical appeals effectively. My experience as a Manager of Clinical Appeals at Allegheny Health Network has enabled me to spearhead initiatives that resulted in a remarkable 100% increase in revenue within my first year. I pride myself on my ability to develop and implement strategies that ensure regulatory compliance while maximizing revenue.
Throughout my career, I have demonstrated a commitment to excellence in patient care and operational efficiency. As a Utilization Review Nurse, I conducted comprehensive reviews to ensure adherence to insurance guidelines, engaging in detailed payer discussions to facilitate pre-certification and authorization processes. My background as a Medical ICU RN has further honed my critical care skills, allowing me to collaborate effectively with multidisciplinary teams to uphold high standards of patient care. I am passionate about mentoring and leading teams, driving departmental goals, and enhancing overall performance.
Experience
Work history, roles, and key accomplishments
Manager Clinical Appeals
Allegheny Health Network
Feb 2022 - Aug 2024 (2 years 6 months)
Spearheaded complex clinical appeals, increasing revenue by 100% within the first year and optimizing reimbursement through intricate payer discussions. Developed and implemented strategies for successful appeals, ensuring regulatory compliance and maximizing revenue. Led and mentored staff, driving departmental goals and enhancing overall performance.
Utilization Review Nurse
Allegheny Health Network
Feb 2018 - Feb 2022 (4 years)
Conducted comprehensive utilization reviews to ensure adherence to insurance guidelines. Facilitated pre-certification and authorization processes, engaging in detailed payer discussions. Maintained current knowledge of healthcare regulations and collaborated with teams to ensure compliance.
Medical ICU RN
Allegheny Health Network
Feb 2016 - Feb 2018 (2 years)
Provided critical care to patients in the Medical Intensive Care Unit, managing complex medical conditions. Educated patients and families on treatment options and health management. Collaborated with multidisciplinary teams to uphold high standards of patient care.
Education
Degrees, certifications, and relevant coursework
Thomas R. Kline School of Law of Duquesne University
Doctor of Law (JD), Law
Activities and societies: Appellate Moot Court Team
Completed a rigorous Doctor of Law program, focusing on legal principles and practices. Participated in the Appellate Moot Court Team, honing advocacy and legal research skills.
Duquesne University Palumbo Donahue School of Business
Bachelor of Business Administration (BBA), Business Administration
Grade: Summa Cum Laude
Activities and societies: Beta Gamma Sigma Honors Society, Wall Street Journal Award for Outstanding Business Student, Phi Kappa Phi, Dean's Award for Academic Excellence
Achieved a Bachelor of Business Administration with Summa Cum Laude honors, focusing on core business principles. Recognized with multiple awards for academic excellence, including the Wall Street Journal Award and Dean's Award.
University of Pittsburgh - School of Nursing
Bachelor of Science in Nursing (BSN), Nursing
Activities and societies: Beta Alpha Phi Honors Society, Robert Woods Johnson recipient, Peer Mentor Program
Pursued a Bachelor of Science in Nursing, gaining comprehensive knowledge in patient care and healthcare practices. Engaged in various extracurricular activities, including the Peer Mentor Program and Beta Alpha Phi Honors Society.
Tech stack
Software and tools used professionally
Availability
Location
Authorized to work in
Job categories
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