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Michelle Palmour
Experienced medical claim denial and revenue cycle specialist
Newberg,OR
Work Preference
Summary
Results-driven claims denial specialist with expertise in claims analysis, denial management, and regulatory compliance. Demonstrated success in optimizing workflows and improving operational efficiency. Proven ability to reduce denial rates and enhance claims processing accuracy.
Overview
23
23
years of professional experience
Work History
Claim Denial Specialist
HCA Hospital/CareNow Urgent Care/Parallon
Coppell, Texas
05.2018 - 10.2025
- Reviewed and evaluated claims to determine if they meet the insurance criteria for reimbursement.
- Reviewed denial claims to identify discrepancies and required documentation.
- Coordinated with healthcare providers to resolve billing issues and denials.
- Analyzed and interpreted policy language, medical records, and other relevant data to identify coverage issues.
- Analyzed insurance policies to ensure compliance with regulations and guidelines.
- Investigated and documented payment errors resulting from incorrect processing of claims.
- Utilized critical thinking skills to evaluate denial patterns and recommend process improvements.
- Ensured compliance with healthcare regulations and insurance policies during the denial management process.
Appeals and Grievance Supervisor
UnitedHealthcare
Plano, Texas
01.2015 - 03.2017
- Directed and supervised team of 15 employees in daily operations.
- Supervised daily operations and workflow management for healthcare service teams.
- Implemented process improvements to enhance team efficiency and service quality.
- Ensured adherence to regulatory standards in healthcare operations and practices.
- Monitored employee productivity to provide constructive feedback and coaching.
- Recruited, hired, trained, mentored, and coached staff.
- Collaborated with other departments to coordinate workflow processes between teams.
- Coordinated communication between departments to support patient care initiatives.
- Fostered a positive and motivating work environment, leading to an increase in team morale.
- Implemented new operational procedures, increasing efficiency.
Appeals and Grievance Team Lead/SME Team Leader
UnitedHealthcare
Plano, Texas
01.2014 - 01.2015
- Resolved escalated customer complaints or queries promptly and efficiently.
- Oversaw compliance with healthcare regulations and internal standards.
- Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
- Analyzed performance data to identify areas for workflow optimization.
- Facilitated communication between departments to ensure smooth operations.
- Mentored junior staff on best practices and company policies.
- Developed training materials for onboarding new team members.
- Trained new staff in relevant processes and procedures.
- Assisted the manager in setting achievable goals for the team while monitoring progress towards them.
Appeals and Grievances Coordinator
UnitedHealthcare
Plano, Texas
04.2003 - 01.2008
- Coordinated appeals process for member grievances and concerns.
- Reviewed and analyzed case files for compliance with regulatory standards.
- Collaborated with cross-functional teams to resolve complex member issues.
- Communicated effectively with members regarding appeal statuses and outcomes.
- Researched case files to ensure accuracy of information prior to making decisions on appeals or grievances.
- Analyzed complex cases to determine appropriate resolution in accordance with relevant laws, regulations and organizational policies.
- Prepared written responses to customers regarding the status of their appeal or grievance filings.
Education
High School Diploma -
Duncanville High School
Duncanville, TX06-1994
Skills
- Claims management
- Claim evaluation
- Insurance compliance
- Regulatory adherence
- Claims process optimization
- Data analysis
- Process improvement
- Medical coding
Timeline
Claim Denial Specialist
HCA Hospital/CareNow Urgent Care/Parallon
05.2018 - 10.2025
Appeals and Grievance Supervisor
UnitedHealthcare
01.2015 - 03.2017
Appeals and Grievance Team Lead/SME Team Leader
UnitedHealthcare
01.2014 - 01.2015
Appeals and Grievances Coordinator
UnitedHealthcare
04.2003 - 01.2008
High School Diploma -
Duncanville High School