Denise serves as the Senior Vice President at Denial Research Group – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse and holds a Master’s degree in Management Information Systems from the University of Illinois, Springfield. Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing. Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases, and presented hundreds of cases at the Administrative Law Judge level.
Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.
I’m Denise Wilson and I am a Senior Vice President at Intersect Healthcare and Denial Research Group. And my role really is to provide support for the clinical team, the clinical team that’s doing actually the the writing of the appeals that we do for intersect healthcare and appeal masters, I kind of help guide us to what is our best practices, help develop what kind of tools we need to get our job done successfully. And make sure that education is on point for our team making sure we’re putting out good quality work, and that we’re being successful for our clients.
So the work that we do in revenue cycle for healthcare providers is important because anytime anyone provides services or products to customers, you deserve to get paid appropriately and in a timely manner. And it’s no different in healthcare. When hospitals or physicians or other health care providers provide medical services to folks in the community, they deserve to be paid appropriately and timely for those services provided. Now it’s a little different in healthcare, because they rely very heavily on insurance companies, medical insurance companies to make those payments and to reimburse them for the services that they provide. Because if they don’t, then that impacts their ability to provide the necessary medical services in the community. So what we do is we advocate for fair and timely compensation on behalf of healthcare providers. And we assist those health care providers in ensuring that the partnerships that they have with those insurance providers that that partnership is providing equitable benefits to the patient, as well as the provider as well as the insurer. So that’s why the the work that we do is so important.
I got into appeal writing accidentally, as I think a lot of people do who work in this industry. So I went to work for a management consulting company. And they were faced with some denials, they were seeing for the services, they are providing these denials, were coming from Medicare. And so I learned while I was working for this company from the nurse who was doing appeals before me who learned from the nurse who was doing the appeals before her, Yes, I just fell into it. But I found that it was interesting work, because I could put my clinical background, my clinical experience to use even though I wasn’t working clinically, to help, you know, ensure that hospitals were being reimbursed correctly. And so it’s a little bit of that, you know, standing up for the hospital standing up for the patient, and making sure that the rules are being followed on both sides, you know, by the hospital and by the provider. And that’s what made it interesting. And when you would see the insurance company actually pay and say, okay, yeah, we agree with you, you’ve you know, you’ve made a good argument, and we agree with you, and we’re gonna pay for those services. It just made you feel like you, you did a good thing.
So what makes intersect healthcare and appeal masters unique from other companies is that from the time the company was created, we have focused on advocating for and assisting our healthcare providers in obtaining appropriate reimbursement for services they provide. So that doesn’t stop with just installation of our software or outsourcing of appeal work to the company. We work with our clients. We collaborate with them to understand what their unique situation is, what their unique set of Payers are, what are the pain points that they’re experiencing? What are the obstacles that they need to overcome? And we work with them as a partner to help provide those solutions to help provide education and not just be seen as an outsourcing agency or the software company that assist them in their revenue cycle.