Medical Insurance
Resume:
Amy S Wesch, CPC
**** **** *** **** ****, Apt ***
Webster, TX 77598
Cell: 636-***-****
Email: **********@*****.***
Objective:
To obtain a position within an organization, that would allow me to work independently, as well as part of a team to achieve maximum revenue and patient satisfaction.
Work History
Nov 2011 to Coder II
Feb 2011 UTMB Physicians’ Billing Service
Galveston, Texas 77555
Reviewed and coded General Surgery; Center for Weight Management and Pediatric Surgical Cases as well as Clinical visits and procedures.
Nov. 2010 to Senior Billing Specialist
Oct 2011 St. Louis Surgical Services and Premier Women’s Health Care Group and formerly Breast Surgeon’s of South County
10012 Kennerly Road, Ste 406 St. Louis, MO 63128
Performed accurate coding and billing for the General Surgeons Group, Breast Surgeons group and OB-GYN Group within St. Anthony’s Physician Organization. I also was to provide Support to other coders within the St. Anthony’s Physician Organization. I assisted and provided coverage for the front desk as needed and audited the electronic charts following additions/scanning from various co-workers. I assisted Group Office Manager with other assigned duties as necessary. Insured accurate coding/billing of all surgical, hospital and office related charges and assisted the Central Billing Office with questions concerning coding and insurance denial and helped when necessary in the appeals process.
Feb 2007 to Coordinator for Medical Coding
August 2010 Washington University/Department of Surgery
Northwest Tower
4490 Children’s Place, Suite 1150; St. Louis, MO 63110
Specializing in the review of physicians’ coding for accuracy and coding of operative reports, consults and Specialty Clinics for Surgical Oncology, as well as Plastic and Reconstructive Surgery. Help in establishing coding guidelines in conjunction with payer polices. Assist new providers in the coding portion during their board certification process. Educate providers on documentation requirements, as well as coding updates and polices. Code Pre-determination and Pre-certification requests, as well as, provide coverage for Pre-certifications/Pre-Determinations, as well as, other specialties in the Department of Surgery and assist in the appeals process when necessary.
May 2004 Quality Control Analyst/Premier Billing Network
To Jan 2007 Washington University School of Medicine
4480 Clayton Ave St. Louis, MO 63110
Review payments for accuracy. Write Appeal letters for all denials on claims, Pre-certifications and Pre-Determinations. Audit coding for accuracy and track trends in payments/denials from various insurance companies. Research patient liability issues. Verify patient responsibility; send patients a notification of possible collection actions on overdue accounts. Research medical necessity based on insurance policies for various procedures that could be considered cosmetic. Assist patients and physicians with billing questions. Help steam line various work flows and answer questions for our claims follow up representative and the Pre-Certification/Pre-Determination representative. Help out on special projects or reports for co-workers when needed. Maintain standards and goal for the department.
August 2000 Claims Examiner/Large Case Management Specialist (LCM)
May 2004 The Epoch Group LC
10795 Watson Rd. St Louis, MO 63127
LCM: Coordinate paperwork between insurance and providers for all catastrophic illnesses and injuries. Facilitate referrals to Large Case Management nurses for review. Document system for all reports Review all pre-certifications and incoming calls for potential large claim issues with possible referral to the LCM Vendors. Record all negotiations and claims received for LCM needs. Scan weekly reports for trigger diagnoses needed for disclosure based on reinsurance needs. Obtain evaluations for transplants and possible transplants. Forward evaluations on to peer review. Act as a resource for claims examiners.
Claims Examiner: Processed Adjusted and review medical, dental and vision claims as well as pre-determinations. Respond to all correspondence received as well as incoming calls from providers and members. Follow up on all overpaid claims with providers. Track all overpaid claims on Excel spreadsheet. Assist other departments as needed.
March 2000 Patient Accounts/Medical Records
To August 2000 Midwest Head & Neck Surgery
9701 Landmark Parkway Dr St Louis, MO 63127
Posted payments to the correct patient accounts from both the patient and the insurance carriers. Submit correct claims and any necessary appeals to insurance companies by both electronic and paper means. Determine based on EOB & provider contract if the claim was paid accordingly. If paid incorrectly write and submit appeals. Follow up on claims status issues. Receive and process all medical records requests sent into the practice. Handle various related office duties and fielded questions for both patients and
co-workers within the office.
Oct 1998 Claims Benefit Specialist
To March 2000 Aetna US Healthcare
3500 W Coliseum Blvd. Ft, Wayne, IN
Complete and error free processing of medical claims in a timely manner. Acted as Mediator when claim and policy was in conflict. Assisted in the on the job training of new claims examiners. I also assisted in other various departments/positions though out the office as needed, with little disruption of service to the client.
Education: Medical Terminology Certificate of completion (1998-Dean Vaughn)
Refresher Medical Terminology Certificate of completion (2005-WUSM)
AMA & AHIMA Coding Audio Seminars when available through WUSM
Certifications: AAPC Coding Certification (CPC) obtained in 2007
Community Clubs/Organizations:
2005-2007 Elected Board Member – Ponderosa CB Club, Jefferson County, Missouri
2007 Appointed by Board Members as Administrator of Records for Ponderosa CB Club
2007 Elected 3rd Vice (Hospital Chair) AMVETS Post 42, Herculaneum, Missouri
2008-2009 Elected Coding Educator for the AAPC St. Louis, East Chapter
References Available Upon Request
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