Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Erin Wessley

SUSSEX,WI

Summary

Nurse Analyst with extensive experience at Ascension WI, specializing in appeals management and regulatory compliance. Achieved a 99.4% quality score through effective communication and data analysis, enhancing patient care and optimizing medical audit outcomes. Proficient in patient care management, emergency response, and infection control, contributing to high productivity and efficient task execution. Strong collaborator focused on delivering optimal patient outcomes in diverse healthcare settings.

Overview

23
23
years of professional experience
1
1
Certification

Work History

Nurse Analyst

Ascension WI
, USA
10.2023 - Current
  • Review all federal audit (Recovery Audit Contractor (RAC), Medicare Administrative Contractor, Supplemental Review Contractor) additional documentation requests. Review medical records for accuracy and completeness before sending them to the auditor.
  • Respond to all RAC denials via written discussion submitted by RN, MD-to-MD conversation if applicable and appeals (there are four levels of appeal with Medicare, we historically respond as far as the ALJ). Denials may be due to coding or documentation- always need to investigate, send additional information, appeal, possibly include the medical director.
  • Respond to all Targeted Probe & Educate audits from National Government Services: Review medical records for accuracy and completeness before sending to auditor, Arrange and lead education calls with the auditing entity, appropriate leaders, affected departments. Provide education to individual providers, departments, etc. regarding audit results, suggested changes, etc.
  • Review all assigned inpatient, outpatient or observation medical necessity, billing, coding, clinical validation, NCD/LCD and readmission denials for Ascension Wisconsin to determine if the denial can be appealed.
  • Review of 1 midnight Medicare inpatient hospitalizations prior to billing to ensure appropriateness of medical necessity and compliance with the Medicare 2 Midnight rule and referring to physician advisors for secondary review if needed.
  • Develop and compose logical and insightful appeal responses and letters to clinical denials after extrapolating applicable data from the medical record to support our position.
  • Timely submission of appeals until cases are overturned or there are no further appeal options.
  • RN could write up to three appeal letters depending on the insurance company and how many levels of appeal are allowed. RNs work directly with the insurance companies via telephone and email to get denials reprocessed, overturned, request observation rebills and obtain appeal results.

Medical Management/Appeal RN

National Government Services
MKE, USA
08.2008 - 10.2011
  • Investigate provider claims utilizing medical record review, policies, and procedure and Medicare guidelines for appropriateness of payment.
  • Investigated provider and beneficiary appeals for Medical claims and developed correspondence to them explaining the review findings in a concise letter format.
  • Strong quality focus and overall score of 99.4% on monthly quality checks on decision making and letter composition. Widely recognized as a top producer of claim production and team player.
  • Expert in the review of Medicare.
  • Worked in collaboration with the Medical Director to discuss new Medicare policies, National Coverage Determination and Local Coverage Determination for our region.

Clinic Nurse

The Kidney Institute, Ltd
Milwaukee, WI
01.2003 - 08.2008
  • Managed a high volume of vulnerable patients on peritoneal dialysis with chronic medical histories.
  • Coordinated care is provided face-to-face and via telephone, based on individualized care plans.
  • Established comprehensive patient support, including assessment, counseling, and educational resources.
  • Available for on-call assistance nights and weekends to address urgent patient needs.
  • Administered medications and monitored patient responses in clinical settings.
  • Collaborated with multidisciplinary teams to coordinate comprehensive patient care.
  • Conducted routine diagnostic tests and interpreted results promptly.
  • Implemented infection control protocols to ensure patient safety consistently.
  • Trained new nursing staff on clinic procedures and best practices thoroughly.
  • Administered medications and immunizations as prescribed by a physician.
  • Monitored vital signs, laboratory results, and other health data.
  • Maintained accurate patient records and documentation according to clinic standards.
  • Answered patient questions regarding their medical conditions or treatment plans.
  • Coordinated referrals for specialty services when needed.
  • Observed, recorded and reported patients' conditions and reactions to drugs and treatments.
  • Collected blood samples using phlebotomy best practices and labeled specimens for testing.
  • Provided patient assessments and care plans.

Education

Bachelors of Science - Nursing

University of Wisconsin Milwaukee
Milwaukee, WI
12.1999

Skills

  • Medical record review
  • Regulatory compliance
  • Quality assurance
  • Clinical documentation
  • Appeals management
  • Data analysis
  • Care coordination
  • Patient education
  • Interdisciplinary collaboration
  • Effective communication
  • Time management
  • Medication and IV administration
  • Policy compliance
  • Patient assessment
  • RN case management
  • Wisconsin nursing license
  • Care plan implementation
  • Outpatient care

Certification

Registered Nurse, Wisconsin, #135397-30, 02/28/2026

Timeline

Nurse Analyst

Ascension WI
10.2023 - Current

Medical Management/Appeal RN

National Government Services
08.2008 - 10.2011

Clinic Nurse

The Kidney Institute, Ltd
01.2003 - 08.2008

Bachelors of Science - Nursing

University of Wisconsin Milwaukee

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