Autumn Setley
Summary
Results-driven healthcare operations professional with a track record of recovering over $1.2 million through strategic appeal submissions and compliance efforts. Expert in analyzing clinical documentation and identifying root causes of denials, driving process improvements that enhance operational effectiveness. Proven ability to train teams and foster collaboration across departments to achieve optimal healthcare outcomes.
Overview
8
8
years of professional experience
Work History
Clinical Denials Specialist
Guidehouse
08.2025 - Current
- Analyzed denied healthcare claims, clinical documentation, and payer policies to identify root causes and resolve documentation gaps, supporting compliant reimbursement strategies.
- Prepared evidence-based appeal documentation aligned with payer guidelines, regulatory requirements, and organizational compliance standards.
- Completed 300+ insurance appeal follow-ups, supporting timely claim resolution and improved reimbursement outcomes.
- Contributed to the recovery of more than $1.2 million in insurance payments through detailed appeal submissions, documentation analysis, and collaboration with revenue cycle teams.
- Conducted detailed reviews of medical records, coding information, and payer requirements to evaluate claim accuracy and identify workflow improvement opportunities.
- Identified recurring denial trends and documentation issues to support process improvements and enhance healthcare operations.
- Collaborated with clinical, coding, and operational stakeholders to improve documentation accuracy, compliance, and claim quality.
- Trained and mentored 5-15 new team members daily on denial management workflows, appeal preparation, documentation standards, and quality expectations.
Electronic Health Record (EHR) Trainer
Aria Community Health Center
12.2024 - 07.2025
- Designed and delivered electronic health record training programs for clinical and administrative staff to improve documentation accuracy, workflow consistency, and system utilization.
- Trained 5-15 employees daily on onboarding needs, adapting approaches to different learning styles and technical understanding levels.
- Developed and customized training materials to enhance employee understanding and knowledge retention for improved workflow adoption.
- Collaborated with clinical and administrative leadership to identify workflow gaps and implement targeted documentation improvements.
- Conducted nursing documentation audits to evaluate record accuracy, completeness, compliance, and adherence to organizational standards.
- Performed onsite assessments at healthcare locations to evaluate equipment functionality and support uninterrupted clinical operations.
- Updated pharmacy drug codes and maintained electronic medical record information to improve data accuracy and system reliability.
- Supported HIPAA compliance and organizational policies through training, auditing, and quality improvement activities.
Medical Assistant
Respiratory Critical Care & Sleep Specialist
01.2024 - 07.2024
- Assisted providers with patient assessments, medical workups, and clinical documentation using eClinicalWorks.
- Administered vaccinations according to established clinical protocols and safety standards.
- Facilitated clinical operations through patient intake, scheduling, insurance verification, referrals, and follow-up coordination to enhance patient experience.
- Coordinated communication among patients, providers, and healthcare teams, ensuring seamless care delivery.
- Maintained accurate patient records supporting continuity of care, billing accuracy, and regulatory compliance.
- Streamlined clinic workflows through documentation review, organization, and administrative coordination, improving operational efficiency.
Medical Documentation Specialist
ScribeAmerica
07.2022 - 05.2023
- Produced accurate real-time clinical documentation in Epic electronic health records on behalf of physicians during patient encounters.
- Reviewed medical records and clinical notes to clarify missing, incomplete, or inconsistent information, enhancing documentation accuracy.
- Analyzed documentation quality to ensure accuracy, completeness, and compliance with healthcare standards.
- Trained new employees on clinical documentation workflows and electronic health record processes, ensuring understanding of documentation expectations.
- Ensured HIPAA compliance while facilitating accurate and timely completion of medical records.
Clinical Documentation Specialist
Medline
03.2021 - 05.2022
- Reviewed healthcare documentation for accuracy, completeness, and data integrity, enhancing overall compliance.
- Evaluated records for discrepancies and collaborated with cross-functional teams to resolve documentation issues.
- Supported quality assurance initiatives by analyzing documentation and reviewing workflows, contributing to improved documentation standards.
- Maintained accuracy and productivity while managing high-volume documentation responsibilities.
Certified Nursing Assistant
Aspired Living
12.2018 - 03.2021
- Delivered direct patient care, ensuring accurate documentation and adherence to healthcare standards.
- Administered medications per established protocols, ensuring timely and accurate patient care records.
- Documented patient information and care activities within electronic health record systems, including Epic.
- Collaborated with interdisciplinary healthcare teams to enhance care coordination and ensure continuity of services.
- Communicated patient updates and changes in condition to support informed clinical decision-making.
Education
Bachelor of Science - Public Health
National University
Online/ San Diego01-2028
Certification - Illinois State Board of Education
Paraprofessional
01-2023
Certification - Pharmacy Technician
Walgreens/ Illinois State Board of Pharmacy
01-2020
Certified Nursing Assistant -
Kirkwood Community College
Coralville, IA05-2018
Skills
- Reimbursement Compliance Standards
- Documentation Quality Standards
- Clinical Documentation Tools
- Root Cause Analysis
- Data integrity
- Revenue Cycle Management
- Data Analysis Techniques
- Process improvement
- Cross-functional collaboration
- Stakeholder communication
- Documentation Training Programs
- HIPAA Compliance
- Program Analysis and Evaluation
- Electronic health records: EPIC, Athena, eClinicalWorks, NextGen, Cerner, Metrix
Professional Experience Additional Detail
40 Hours/Week listed for each role.
Timeline
Clinical Denials Specialist
Guidehouse
08.2025 - Current
Electronic Health Record (EHR) Trainer
Aria Community Health Center
12.2024 - 07.2025
Medical Assistant
Respiratory Critical Care & Sleep Specialist
01.2024 - 07.2024
Medical Documentation Specialist
ScribeAmerica
07.2022 - 05.2023
Clinical Documentation Specialist
Medline
03.2021 - 05.2022
Certified Nursing Assistant
Aspired Living
12.2018 - 03.2021
Bachelor of Science - Public Health
National University
Certification - Illinois State Board of Education
Paraprofessional
Certification - Pharmacy Technician
Walgreens/ Illinois State Board of Pharmacy
Certified Nursing Assistant -
Kirkwood Community College