Kelli Felske
Minneapolis,MN
Summary
To seek and maintain a position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
9
9
years of professional experience
Work History
Senior Reimbursement Analyst
Medtronic
02.2018 - 07.2023
- Support and implement reimbursement programs to obtain coverage, coding, and payment from payers (Medicare and commercial) and support U.S
- Providers; including direct interactions with payers and other related entities to gain reimbursement for Medtronic therapies
- Represent the reimbursement functional perspective and provide input to product development teams, marketing, sales, regulatory, and clinical leaders
- Support comprehensive market access strategies through the integration of U.S
- Reimbursement mechanisms and policies, health technology assessment, evidence-based medicine review, and health economic modeling activities
- Function confidently in a matrixed, complex organization to assess, recommend, and implement solutions in a fast-moving business environment
- Work with colleagues across multiple geographic settings, virtual and office-based, and with a variety of business functions
- Work with Health Economic Policy Reimbursement strategies within the broader business context to implement reimbursement programs that are integrated into the overall business strategy
- Partner with industry stakeholders and physician societies in the development and implementation of reimbursement strategies and complete market access submissions
- Review and understand U.S
- Reimbursement and payment systems, including Medicare payment systems, payer coverage policies, claims data sets, and sources of U.S
- Health data
- Continuous monitoring of U.S
- National and regional reimbursement trends and payment policy changes to identify opportunities & risks to market entry
- Create and manage interactive dashboards, reports, and similar content
- Create training and deliver education programs to sales force, physicians, medical directors, billing personnel, distributors, and other external stakeholders as needed.
Senior Provider Education Consultant-Payment Integrity
Optum
09.2016 - 12.2017
- Provide coding education to providers and business office staff to help providers get off of medical record review by writing letters, creating and providing provider data reports, meeting by phone and frequent email communication
- Create, prepare and scrub Provider Data Reports in Excel and Report Manager
- Review and audit pre-pay provider claims for accuracy.
Lead Clinical Investigator
Optum
03.2016 - 09.2016
- Assign claims to staff
- Weekly meeting check-ins with staff
- Assist in system training for new and existing team members
- Assist manager in team activities/education
- Review and complete claim reconsiderations
- Triage team questions
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Clinical and/or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review
- Interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Perform clinical coverage review of pre-payment claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
- Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing
- Identify aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review
- Maintain and manage daily case review assignments, with a high emphasis on quality
- Provide clinical support and expertise to the other investigative and analytical areas
- Participate in training of new staff, and serves as a clinical resource to other areas within the clinical investigative team.
Clinical Investigator-Telecommute
Optum
12.2014 - 03.2016
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Clinical and/or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review
- Interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Perform clinical coverage review of pre-payment claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
- Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing
- Identify aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review
- Maintain and manage daily case review assignments, with a high emphasis on quality
- Provide clinical support and expertise to the other investigative and analytical areas
- Participate in training of new staff, and serves as a clinical resource to other areas within the clinical investigative team.
Education
B.S. in Health Information Management -
University of Cincinnati
AAS in Health Information -
Rasmussen College
Coding Specialist Certificate -
University of St. Catherine
Skills
- Effective Communication
- Adaptability
- Problem Solving
- Team Collaboration
- Attention to Detail
- Clerical Writing
- Client Service
- Microsoft Office
- Policy Evaluation
- Compliance Reporting
Timeline
Senior Reimbursement Analyst
Medtronic
02.2018 - 07.2023
Senior Provider Education Consultant-Payment Integrity
Optum
09.2016 - 12.2017
Lead Clinical Investigator
Optum
03.2016 - 09.2016
Clinical Investigator-Telecommute
Optum
12.2014 - 03.2016
B.S. in Health Information Management -
University of Cincinnati
AAS in Health Information -
Rasmussen College
Coding Specialist Certificate -
University of St. Catherine
Similar Profiles
Himanshu BhagboleHimanshu Bhagbole
Territory Business Manager at MedtronicTerritory Business Manager at Medtronic
Gurpreet SinghGurpreet Singh
Country Sales Manager at MedtronicCountry Sales Manager at Medtronic
Jennifer RossmannJennifer Rossmann
Senior Sales Representative at MedtronicSenior Sales Representative at Medtronic
Mohamed HassanMohamed Hassan
Senior Software Engineer at MedtronicSenior Software Engineer at Medtronic
HAFID MOHAMEDHAFID MOHAMED
Security Officer at Unparalleled SecuritySecurity Officer at Unparalleled Security