CHRISTINE WELLS

Qualifications Summary

Experience in the health services field with primary focus and

Specialization in the areas of Medicare compliance, HIPAA, and compliance

coding for Medicare. In depth understanding of the processes of patient

registration, insurance verification and appeals. Proficient in the use of Microsoft Office Suite.

Professional Experience

Wellcare, Louisville KY 10/2016 to current

Appeals Coordinator

Research member Medicaid appeals for pre service / Retrospective procedures including vision, dental, and behavior health

Documented research, phone calls, and requests for documentation surrounding case

Entered authorizations for approved procedures

Worked with vendors, providers, and members to acquire necessary information for case

Kentucky Health Cooperative, Louisville KY 9/2014- 10/2016

Intake Coordinator

Screen, verify and report member information

Complete prior authorization intake form for each telephone inquiry, obtain and verify information

Obtain and manage information effectively related to facilitate admission, continued stay, and discharge

Collect necessary clinical information

Beta tested Scripts in Altruista for future use in KYHC.

Humana – Louisville, KY 11/2011-11/2013

Pre-service appeals specialist

Research member appeals / provider appeals for pre service procedures

Documented research, phone calls, and requests for documentation surrounding case

Entered authorizations for approved procedures

Prepared cases for federal CMS on cases not approved for service

Worked with vendors, providers, and members to acquire necessary information for case

Self employed - Crestwood, KY 8/2010-11/2011

Private care

Sunrise Senior Living- Louisville, KY 9/2009- 8/2010

Resident care

The Rawlings Group – LaGrange, KY 12/2008 – 03/2009

Outbound Call Center Representative

Verified Medicare eligibility of patients (achieved top performer award for this work)

RxCrossroads – Louisville, KY 8/2008 – 11/2008

Patient Advocate

Coordinated the shipment of medication to physicians or patients.

Coordinated home health care

Verified patient insurance

Assisted patient in completion of financial aid process

Coordinated program to ensure physician’s office and patients were satisfied with process and product.

Baptist Hospital Northeast – LaGrange, KY 9/2000 – 08/2008

Patient Access Clerk and Medicare Compliance Coordinator

Worked directly with Supervisor in the development of the One-Call Process.

Responsible for testing process and evaluating for quality assurance.

Insured registrations for Medicare recipients were completed correctly and in compliance with Medicare guidelines.

Revised policy and procedure manual for Medicare compliance (now used by all Baptist hospital facilities).

Managed the insurance and employer databases, reviewed databases to determine presence of accurate information and maintained as required.

Responsible for educating new-hires in Medicare compliance, HIPAA, and compliance coding for Medicare.

Tova Industries, Inc. – Louisville, KY 09/1997-09/2000

Assistant Production Manager

Ordered required materials for production.

Coordinated shipment for all products.

Supervised completion of all scheduled production.

Managed staffing requirements for shift work.

Assisted in the research and development of new products.

Art & Type Compositors – LaGrange, KY 10/1994-09/1997

Co-Proprietor

Responsible for marketing and sales.

Responsible for all bookkeeping and payroll.

Responsible for responding to needs of customer and setting appointments

United States Army Reserve 10/1986-09/1994

Medical Supply Specialist for 807th Mobile Army Surgical Hospital (M.A.S.H.)

Developed fully operational supply division from the ground up.

Ensured 100% compliance with Army Regulations by passing all Inspector General Inspection requirements.

Generated four new army personnel positions required to support daily operational supply mission.

Primary administrator for the inventory of small arms (weapons) to unit personnel during contingencies and operations.

United States Army Active Duty 12/1982-09/1986

General Supply Specialist

Provided administrative oversight for unit supply, small arms (weapons), and vehicle operations offices.

Verified all records and documentation were correctly completed and filed in accordance with Army Regulations.

Met or exceeded Inspector General Inspection criteria.

Education

Associate Degree, Medical Billing and Coding, Colorado Technical University

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