Dawn J. Wesche

Email: abpjt0@r.postjobfree.com

Address:

City: East Moriches

State: NY

Zip: 11940

Country: USA

Phone: 631-***-****

Skill Level: Any

Salary Range:

Primary Skills/Experience:

Billing account manager with experience supporting many physicians in their busy Manhattan, NY and New Jersey based medical practices. Reliable multi-tasker with strong emphasis in plastic micro surgical reconstruction and anesthesiology. Expertise includes surgical coding and billing for in-patient, out-patient, and emergency room procedures for out of network providers. Strong knowledge base of appeal techniques and coordinating state and federal laws with an extremely high rate of success. Highly efficient in all aspects of medical billing/coding including verifying insurance coverage, securing pre-certifications and pre-determinations. Patient-focused, e nthusiastic with excellent people skills and dedicated work ethic. Strong attention to detail and extensive knowledge of medical terminology.

Educational Background:

High School Dipolma from SUNY Farmingdale, Farmingdale NY 1/2001 to 6/1981 (Nursing)

High School Dipolma from Hauppauge High School, Farmingdale NY 1/2001 to 11/2012

Job History / Details:

Professional Summary

Billing account manager with experience supporting many physicians in their busy Manhattan, NY and New Jersey based medical practices. Reliable multi-tasker with strong emphasis in plastic micro surgical reconstruction and anesthesiology. Expertise includes surgical coding and billing for in-patient, out-patient, and emergency room procedures for out of network providers. Strong knowledge base of appeal techniques and coordinating state and federal laws with an extremely high rate of success. Highly efficient in all aspects of medical billing/coding including verifying insurance coverage, securing pre-certifications and pre-determinations. Patient-focused, enthusiastic with excellent people skills and dedicated work ethic. Strong attention to detail and extensive knowledge of medical terminology.

Skill Highlights

Proficient in CPT coding and billing

Extensive anatomy/physiology knowledge

Plastic microsurgical reconstructive surgery, and anesthesia experience

Billing and coding of in-patient, out-patient and ER procedures for out of network providers

Knowledge of HMOs,Medicare and Medicaid

Maintains strict confidentiality

Medical Manager Software

Managed care contract knowledge

Electronic Medical Record (EMR) software

ICD-9 coding

CPT coding

Confident public speaker

Government relations knowledge

Personal and professional integrity

Staff training in plastic surgical breast reconstruction techniques

In-depth claims knowledge

Claims analysis and review specialist

Critical thinking proficiency

Appeals Specialist attaining proper reimbursement for out of network providers

Maintain good rapport with governmental contacts at the DOI and Atty General's Office.

Workers comp and no-fault knowledge and billing.

Verifying patient insurance benefits and coverage

Obtaining pre-certifications, pre-determinations and retro authorizations.

Strong negotiations techniques for single case agreements

Negotiated and Secured global contracts with 3rd party payers for over 40 providers and OBS facilities.

Quality assessment of coded data

HIPAA compliance

Strong planning skills

Technical knowledge of computer hardware and software

Patient advocate

Strong work ethic

Team player with positive attitude

Deadline-driven

Good written communication

Exercises good judgment

Form creator of specialized appeals templates.

Career Chronology

October 2007 to Current

P.C. Advantage, Inc. Center Moriches, New York

Account Medical Billing Manager

January 1990 to May 2009

D. Wesche Monuments Center Moriches, New York

Owner/Operator

July 1989 to May 2009

Wesche Funeral Home, Inc. Center Moriches, New York

Owner

January 1987 to January 1989

Herrmann's Funeral Home, Inc. Center Moriches, New York

Personal Assistant/Secretary

April 1985 to January 1987

McCormick Towing Co. Hempstead, New York

Chef

January 1979 to April 1985

European American Bank Melville, New York

Bank Teller/Platform Representative

Education and Training

1981 SUNY Farmingdale Farmingdale, New York

Nursing

1978 Hauppauge High School Hauppauge, New York

High School Diploma Science/Biology

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