Paula Copain, RN Esq.

Experience

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  Clinical Experience

  Jan 1981 - Jan 2007

  Clinical assessment and care of the adult home health patient, qualification of patients for Medicare service eligibility, creation and implementation of patient care plans, case management of professional and ancillary patient services and supervision of Licensed Practical Nurses and Home Health Aides. Completing of paper and electronic home health documentation and Medicare Oasis documentation.Gallagher Home Health ServicesHarvey Home Health ServicesNew York Presbyterian Home Health AgencyGirling Health CareNursing Sisters Home Visiting ServiceNew York Methodist Hospital Certified Home Health AgencyVictory Memorial Long Term Care Home Health ProgramFamily Care Certified Services of Brooklyn(Home Care Coordinator and Team Leader) Show less

  • Home Health Visiting Nurse

    Jan 1995 - Jan 2007

  • Nephrology Nursing

    Jan 1983 - Jan 1995

  • Medical/Surgical Nursing

    Jan 1981 - Jan 1983
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  South Brooklyn Nephrology Center

  Jan 1991 - Jan 1994

  Nursing Care Coordinator

  Overall management and staff supervision of an out-patient Dialysis facility. Development of clinical nursing ,technical staff and patient educational programs. Participation in State Department of Health surveys and mandatory reporting to the End Stage Renal Disease Network.

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  The Methodist Hospital Visiting Nurse Association of Houston

  Jan 2002 - Jan 2003

  Patient Care Supervisor

  Overall management of a hospital based home health agency. Oversight of patient and staff scheduling, patient compliant resolution, staff education and evaluation. Liaison with Medicare and Managed Care providers for service approvals and resolution of claim denials. Participation in State Department of Health surveys, quality assurance and risk management activities.

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  Home Health Quality Assurance Consultant

  Sept 2006 - Aug 2015

  Home Health Quality Assurance Consultant

  Quality review and audit of home health medical records and Oasis documentation. Identification of trends negatively impacting on patient care outcomes. Development of audit tools. Creation of outcome reports with corrective action plans. Development of patient and staff educational tools and agency policies.

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  Widener University HELP:MLP at Crozer Keystone Healthy Start

  May 2013 - Sept 2013

  Law Clerk

  General legal research and analysis, preparation of court documents with specific focus on SSI Bluebook disability criteria. Medical record review and preparation of records for SSI disability review, disability case preparation and client representation at administrative Social Security Disability hearing.

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  KeystoneCare Home Health and Hospice

  Aug 2014 - Aug 2015

  Director of Quality Assurance

  Oversight and management of the Quality Assurance Nursing team and Medical Records Department. Medical record review and audit of Home Health, Field Hospice and In House Hospice programs with identification of negative trends, development of intervention strategies and outcome based evaluation tools. Chair of the Agency Quality Assurance and Performance Improvement Program. Oversight of home care staff orientation program. Participation in department of health surveys for Home heath and Hospice and development of corrective plans. Show less

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  Cotiviti, LLC; formerly Connolly iHealth Technologies, LLC

  Sept 2015 - now

  Senior Appeals Auditor, Cotiviti LLC

  Utilization of healthcare and auditing experience to perform detailed medical record review. Creation of clinical summaries identifying key factors, strengths and weaknesses in the record for use in oral argument at ALJ hearing. Drafting of hearing briefs for submission to the ALJ and participation in oral arguments at ALJ hearing to defend Cotiviti's original claim payment recovery efforts on the behalf of Medicare.