Jieselle Unique Crisol

Registered Nurse (RN) and Certified Inpatient Coder with hands-on experience in U.S. healthcare operations, medical review, clinical documentation analysis, claims review, and denial management. My professional background includes DRG Clinical Validation Audit (DRG-CVA) and Short Stay Billing Verification (SSBV), where I performed patient chart review, ICD diagnosis validation, medical necessity evaluation, denial analysis, and healthcare documentation review using payer guidelines and clinical review tools. Key experience includes: • DRG / ICD diagnosis validation • Patient chart & medical record review • Medical necessity review & inpatient appropriateness assessment • Claims & denial review • Denial rationale / denial letter writing • Clinical case summarization • Healthcare documentation analysis • Revenue cycle & healthcare operations support Tools & exposure: • InterQual • Revenue Cycle Pro • DRG clinical validation workflows • U.S. healthcare payer exposure (UHC, WellMed, Aetna) As part of DRG-CVA, I reviewed clinical documentation to validate primary and secondary diagnoses against billed ICD coding and established review guidelines. Within SSBV, I reviewed denied claims, summarized patient stays, evaluated inpatient hospitalization appropriateness using InterQual and supporting documentation, and prepared denial rationale based on clinical findings and payer criteria. I am available for opportunities involving: • Medical Review • Chart Review / Medical Records Review • Claims & Denials Support • Healthcare Operations / RCM Support • Coding-related review work • Healthcare Documentation Analysis • Specialized Healthcare Virtual Assistance • Medical Summaries & Clinical Documentation Projects If you need a healthcare professional with combined experience in nursing, inpatient coding, clinical documentation, and U.S. healthcare review workflows, I would be glad to support your team.