Amy Wilkinson
Alderson,WV
Summary
Detail-oriented Medical and Health Services Manager passionate about facilitating excellent patient care. Adept at designing and implementing policies and procedures, with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
17
17
years of professional experience
Work History
Primary Care Clinic Manager
CAMC Greenbrier Valley
Lewisburg , WV
02.2023 - Current
- Managed daily operations of the clinic, including scheduling appointments and assigning staff.
- Ensured that patient care standards were met by providing training and guidance to healthcare professionals.
- Developed policies and procedures for the clinic to ensure quality service delivery.
ACCOUNT RESOLUTION SPECIALIST/ Team Lead
chs bethlehem SHARED SERVICE CENTER
07.2016 - Current
- Medicare Repricing Analysis for Reference-Based Pricing
- Manage Open Negotiation appeal for No Surprise Balance Bill Act
- Monitor and track project performance data with Excel spreadsheets to generate reports and keep management information of important trends
- Enter and re-price Medicare charges accurately, revise errors
- Post payments in a timely manner
- Document payment records and issues as they occur
- Review documentation to confirm diagnosis and CPT procedure codes for encounters
- Process follow up on payer denials, consulting with the patient and/or family as needed
- Perform full research to check claims and possible solutions to individual issues
- Review accounts with aging balances and contact customers to review options
- Evaluate each customer’s situation with fresh eyes in order to develop most effective solution
- Maintain confidentiality of patient data in compliance with HIPAA
- Work accounts utilizing a broad range of collection strategies
- Work very closely with hospital management to impact collection efforts
- Support special projects assigned by supervisor or manager.
customer service representative for national accounts
Aetna Life Insurance Company
04.2015 - 07.2016
- Answered questions and resolved issues based on phone calls/letters from members, providers, and plan sponsors
- Triaged resulting rework to appropriate staff
- Documented and tracked contacts with members, providers and plan sponsors
- Explained member's rights and responsibilities in accordance with contract
- Processed claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system
- Handled customer service inquiries and problems via telephone, internet or written correspondence
- Handled extensive file review requests
- Assisted in preparation of complaint trend reports
- Assisted in compiling claim data for customer audits
- Determined medical necessity, applicable coverage provisions and verified member plan eligibility relating to incoming correspondence and internal referrals
- Handled incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management
- Performed review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
- Performed financial data maintenance as necessary.
clinical coordinator/ medical assistant
Dr. Pamela Meyer - Dermatology
04.2007 - 04.2015
- Opened and closed office as needed including prepare and supply rooms
- Assisted Physician with hiring and interviewing new employees
- Instruction of students for externships
- Assisted physicians with all procedures and direct patient care
- Assessed patient vitals, recorded medication/allergies
- Managed outside labs
- Managed I Pledge/Accutane management system
- Prepared and assisted Physician with sterile field surgical procedures
- Managed in house Lab including CLIA compliance, proficiency testing
- Managed Emergency / On Call cell phone
- Compiled Letters to referring doctors.
Education
Skills
- Medical data acquisition
- Reporting and documentation
- Critical decision-making skills
- Ability to problem solve
- Analyze data, and identify trends
- Able to work under pressure
- Strong written and verbal communication
- Crisis Management
- Staff Scheduling
- Medical Procedures Scheduling
- Clinic Scheduling
- Scheduling Appointment
- Patient Care Advocacy
- Organizing Staff Schedules
- Patient Health Education
- Policy Updates
- Attention To Detail
- Addressing Questions And Concerns
- Meeting Participation
- Training And Mentoring
- Records Management
- Critical Thinking
- Medical Records Management
- Administrative Leadership
- Recordkeeping Requirements
- Strong Work Ethic
- Billing And Coding
Timeline
Primary Care Clinic Manager
CAMC Greenbrier Valley
02.2023 - Current
ACCOUNT RESOLUTION SPECIALIST/ Team Lead
chs bethlehem SHARED SERVICE CENTER
07.2016 - Current
customer service representative for national accounts
Aetna Life Insurance Company
04.2015 - 07.2016
clinical coordinator/ medical assistant
Dr. Pamela Meyer - Dermatology
04.2007 - 04.2015
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