Summary
Overview
Work History
Education
Skills
Affiliations
References
Timeline
Generic

Michelle Werner

Groves,TX

Summary

Results-driven healthcare professional with extensive experience at United Health Care Optum, specializing in provider reimbursement and relations. Proven expertise in healthcare coordination and developing standard operating procedures that drive process efficiencies. Strong relationship-building skills lead to high satisfaction levels and effective conflict resolution. Dedicated to leveraging analytical problem-solving abilities to enhance operational workflows.

Overview

17
17
years of professional experience

Work History

Provider Reimbursement Specialist

United Health Care Optum
Groves, TX
03.2020 - 02.2025
  • Assisted in developing new processes for more efficient management of reimbursement requests
  • Created detailed spreadsheets documenting all claim information made by the organization
  • Investigated complex cases involving multiple providers or incorrect coding and billing issues
  • Verified clients' insurance claims coverage by coordinating with providers
  • Monitored claim details for non-payments, delayed payments, and other irregularities
  • Answered customer questions to maintain high satisfaction levels
  • Reviewed engine assigned codes and modifiers to update and verify accuracy
  • Participated in annual reviews of existing SOP's related to business process's

Provider Relations Advocate

United Healthcare Optum
Groves, USA
05.2015 - 02.2025
  • Participated in facility aging's to ensure quality relationship with customers
  • Attended conferences and seminars focused on healthcare industry trends that may affect provider relations activities
  • Received patient inquiries or complaints and directed to appropriate medical staff members
  • Facilitated meetings between united personnel and external providers such as Nursing Facilities
  • Collaborated with Nursing facilities and administrative staff to meet patient needs
  • Instructed providers on procedures and policy limitations for and plans
  • Maintained accurate records of all communications with providers including emails, letters, phone calls
  • Assisted providers in understanding their contractual obligations and ensured timely resolution of any discrepancies or disputes
  • Customized onboarding plans to meet the specific needs of different facilities and members
  • Scheduled or conducted new facility orientations for new products

Assistant Manager

Gulf Health Care Center
Port Arthur, TX
08.2008 - 05.2015
  • Mediated conflicts between employees and facilitated effective resolutions to disputes.
  • Created and managed budgets for travel, training, and team-building activities.
  • Organized team activities to build camaraderie and foster pleasant workplace culture.
  • Submitted claims to insurance companies.

Education

Some College (No Degree) - General Studies / Art History

Lamar University
Beaumont, TX
01-2005

Skills

  • Healthcare Coordination
  • Creating Standard Operating Procedures
  • Claims Evaluation
  • Insurance Eligibility Verification
  • Analytical Problem Resolution
  • Provider Relationship Development
  • Informative Presentation Skills
  • Workforce Development and Engagement
  • Facilitating Provider Onboarding
  • Interpersonal Conflict Navigation
  • Field Evaluations
  • Quality Assessment

Affiliations

  • Oil Painting
  • Volunteering with multiple non-profits
  • Herb Gardening

References

References available upon request.

Timeline

Provider Reimbursement Specialist

United Health Care Optum
03.2020 - 02.2025

Provider Relations Advocate

United Healthcare Optum
05.2015 - 02.2025

Assistant Manager

Gulf Health Care Center
08.2008 - 05.2015

Some College (No Degree) - General Studies / Art History

Lamar University

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Michelle Werner