Atlanta, GA *****
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