**** ***** ******* **

Atlanta, GA *****

414-***-****

acunpy@r.postjobfree.com

WYKEKIE VADEN

OBJECTIVE

Experienced revenue cycle healthcare professional seeking position within a growing company to utilize experience with financial counseling, preregistration and precertification.

SKILLS & ABILITIES

62 wpm typing

10-key calculator

CAC trained – not certified

National Readiness Certificate – Silver – 2011

EXPERIENCE

FINANCIAL COUNSELOR, CHILDREN’S HOSPITAL OF WI

April 2013 - present

Assists families and childless adults to apply for Medicaid coverage

Knowledge of ACA policies, procedures and qualifications

Advocates financial assistance options available, process applications for approval

Applying self-pay discounts

Guiding families to explore all options to avoid being without insurance

Upfront collection for elective and cosmetic procedures

Benefit and copay collection

Issue refunds and apply stop-bill

After visit family follow up

Confirming insurance intentions for newborn

Partnering with physicians to determine medical necessity for procedure for self pay patients

Mediating conversations insurance companies and families to assist with formal denials/gathering supporting information to overturn decision

Collaborating with medical librarian to gather supporting information to justify procedure necessity

Systems – EPIC, IDX, US Bank Navigator, WHIN and online insurance websites.

PRECERTIFICATION REP, CHILDREN’S HOSPITAL OF WI

April 2013 – July 2014

Insurance verification

Working work queues in EPIC with 10 business day goal

Selecting CPT and ICD-9 codes to initiate authorizations per physicians orders

Initiating and securing prior authorizations for admissions, PSS, Imaging, Infusion, Specialty clinic office visits, therapies (speech, physical and occupational)

Pursuing insurance companies to appeal denials for no authorization or invalid procedure code billed

Reviewing denial claims from the denial WQ to determine denial reason according to ansi reason code on claim

Partnering with physicians to determine medical necessity when prior authorization is pending

Confirming and updating demographics

Created work flow for Infusion process to overturn and prevent denials – improved denial rate by 156% and received $132,000 in retro payments.

Systems – EPIC, IDX, US Bank Navigator, WHIN and online insurance websites.

PRECERTIFICATION REP, WHEATON FRANCISCAN HEALTHCARE

July 2013 – March 2014

Insurance Verification

Initiating and securing prior authorizations for admissions, PSS, Imaging and Pain Clinic

Assigned to special group for private physicians to secure authorizations for services at Wheaton facilities

OOP collections

Systems - SDK, MCKesson, IDX and Medeanalytics

PRECERTIFICATION REP, GOODWILL TALENT BRIDGE (WHEATON FRANCISCAN HEALTHCARE)

March 2012 – July 2012

Temporary agency – contracted with Wheaton Franciscan Healthcare

PREREGISTRATION REP, FROEDTERT MEMORIAL LUTHERAN HOSPITAL

July 2008 – March 2012

Insurance and benefit verification

Confirming and updating demographics

Obtained authorization requirements for Cancer care at the Cancer Center of Wisconsin

Collaborating with clinic nurses and physicians to ensure that authorizations were in place prior to visits.

Systems - EPIC, IDX, Affinity and NEBO

EDUCATION

KAPLAN UNIVERSITY – HEALTHCARE ADMINISTRATION – CURRENTLY ENROLLED

Current GPA of 3.85

CUSTER HIGH SCHOOL – HIGH SCHOOL DIPLOMA – JUNE 2002

REFERENCES

AVAILABLE UPON REQUEST

Contact this candidate