Megan Boyd
Greene,Maine
Summary
Knowledgeable Healthcare Professional; highly effective at satisfying patient care needs while eliminating unnecessary hospital burdens. Broad knowledge of healthcare services and levels of care, financial options and insurance coverage scope. Known for working positively with care team members to reach creative solutions.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Patient Care Advocate
HealthCare Support / Centene Corporation
12.2023 - Current
- Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices
- Serves to collaborate with providers in the field, to improve HEDIS measures and provides education for HEDIS measures and coding
- Supports the implementation of quality improvement interventions and audits in relation to plan providers
- Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS
- Provides education to members regarding the care gaps they have when in the providers office for medical appointments
- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies
- Acts as the face of WellCare in the provider community with the provider and office staff where their services are embedded
- Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements
- Assess provider performance data to identify and strategize provider opportunities for improvement
Practice Performance Manager / Medicare Consultant
United HealthCare
10.2021 - 04.2023
- Functioning independently, travel across assigned territory to meet with providers to discuss UHC and Optum tools and UHC incentive programs for both risk adjustment and quality reporting, focused on improving the quality of care for Medicare Advantage Members
- Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
- Develop comprehensive, provider-specific plans to increase their HEDIS performance, facilitate risk adjustment suspect closure and improve their outcomes
- Access PCOR to identify risk adjustment opportunities and utilize other available reporting sources including but not limited to (InSite, Spotlight, Doc360, Provider Scorecard, CPT II Report) to analyze data and prioritize gap and suspect closure, identify trends, and drive educational opportunities
- Conduct chart review quarterly and provide timely feedback to provider to improve reporting on a go forward basis
- Conduct additional chart reviews such as a quarterly post-visit ACV review and various focused progress notes reviews with provider feedback to improve documentation and coding resulting in improved gap and suspect closure
- Coordinates and provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
- Utilize Stars measures (HEDIS / CAHPS / HOS / medication adherence), coding for quality care (CPT II) and exclusions (ICD-10-CM), risk adjustment coding practices (ICD-10-CM), and Optum program administration including use of plan tools, reports, and systems
- Lead regular Stars and risk adjustment specific JOC meetings with provider groups to drive continual process improvement and achieve goals
- Provide reporting to health plan leadership on progress of overall performance, MAPCPi, MCAIP, gap closure, and use of virtual administrative resources
- Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
- Ability to use independent judgment, and to manage and impart confidential information
Claim Recovery - Organization OI PI Clinical Ops
Optum
04.2020 - 10.2021
- Investigate, recover, and resolve all types of claims for commercial health plans
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- Adhere to and maintain required levels of performance in both coding accuracy and productivity
- Identify appropriate assignment of CPT and ICD-10 Codes for Physician and facility services provided in an Observation service setting
- Abstract additional data elements during the chart review process when coding
- Maintain a thorough understanding of assigned client coding specifics
- Perform coding duties as appropriate according to pre-determined schedules
- Review and maintain a record of charts coded, held, and/or missing
- Provide documentation feedback to Providers, as needed, and queries Physicians when appropriate
- Maintain up-to-date coding knowledge by reviewing materials disseminated/recommended by the Manager, Coding Operations Managers, and Director of Coding/Quality Management, among others
- Participate in department meetings and educational events.
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
Specialty Coder
Maine Coast Memorial Hospital / Northern Light Maine Coast Hospital
12.2016 - 04.2020
- Works closely with clinical department staff and revenue management departments, under the supervision and guidance of the Coding Manager, to ensure that charges for services are completely and accurately posted, using correct CPT and HCPCS codes, and associating charges with correct ICD-10 diagnosis codes supported by documentation to ensure complete and compliant billing
- Performs duties and tasks in accordance with standards established for coding
- Protects access to highly confidential patient, employee and/or Northern Light Maine Coast proprietary information and must handle protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards
- Responsible for reporting all security events, potential events, or other security risks to the organization
- Responsible for participation in and completion of all patient safety initiatives appropriate to the position and conducts all job responsibilities according to the Mission and Values of Northern Light Maine Coast Hospital.
- Improved code quality by implementing rigorous testing procedures and debugging strategies.
- Enhanced software performance through efficient algorithm design and optimization techniques.
Internal Medical Auditor
Central Maine Healthcare
07.2012 - 12.2016
- Ensure compliance with established internal control procedures by examining records, reports, operating practices, and documentation
- Verifies assets and liabilities by comparing items to documentation
- Completes audit summaries by documenting audit tests and findings
- Maintains internal control systems by updating audit programs and recommending new policies and procedures
- Works as a liaison between the various department heads in order to fully assess internal controls
- Communicates audit findings by preparing a final report, discussing findings with Auditees
- Prepares special audit and control reports by collecting, analyzing, and summarizing operating information and trends
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks and participating in professional societies.
- Enhanced the accuracy of medical billing by thoroughly auditing patient records and identifying discrepancies.
- Streamlined the audit process for increased efficiency by developing and implementing standardized procedures.
Education
Business Administration (Major) -
University of Maine At Orono / University of Southern Maine
MaineWomen's Studies (Minor) -
University of Maine At Orono / University of Southern Maine
MaineHigh School Diploma -
Hebron Academy
Hebron, MESkills
- Healthcare Operations
- Coding and Auditing Compliance
- Provider Relationship Management
- Data Analysis and Reporting
Certification
- CPC, American Academy of Professional Coders, December 2005 – Present
- Emergency Medical Technician (EMT), September 2017 - Present
- Certified interior and exterior Firefighter, November 2015 - Present
- Medical Terminology Course, CMMC School of Nursing, August 2003
- Citizen's Police Academy, October 2008 (VIPS - Volunteer in Police Service member) Advanced class; June 2012
- CERT (Community Emergency Response Team), Maine Emergency Response, April 2010
- Certified Funeral Attendant, August 2019 - Present
- Certified Real Estate Agent, PinePoint Realty -August 2023-Present
References Available
Upon Request
Computer Experience
Macintosh, IBM compatible, Microsoft Excel, Microsoft Word, Microsoft Access, Microsoft Outlook, Microsoft PowerPoint, Citrix (Logician), AS 400 (McKesson), GroupWise, Encoder Pro, SISI, Mediscribe, Adobe, Next Tech, ERNE, Custom Coder, Winmed, EIVF, Intelicode, Cerner, EPIC, Meditech, 3M, Field Assist / Practice Assist, Impact, ECG Quick Connect, Doc 360, Intelligence Studio, Orbit Tableau, Power BI.
Hobbies and Interests
- Cooking
- Outdoor activities
- Reading
Volunteer Experience
- Day Care Center for underprivileged Children
- VIPS program through Auburn Police Department
- CERT program/ MEMA (Maine Emergency Management Association)
- Auburn Fire Department
- Greene Volunteer Fire Department
- MSAD 52 School Board
Timeline
Patient Care Advocate
HealthCare Support / Centene Corporation
12.2023 - Current
Practice Performance Manager / Medicare Consultant
United HealthCare
10.2021 - 04.2023
Claim Recovery - Organization OI PI Clinical Ops
Optum
04.2020 - 10.2021
Specialty Coder
Maine Coast Memorial Hospital / Northern Light Maine Coast Hospital
12.2016 - 04.2020
Internal Medical Auditor
Central Maine Healthcare
07.2012 - 12.2016
Business Administration (Major) -
University of Maine At Orono / University of Southern Maine
Women's Studies (Minor) -
University of Maine At Orono / University of Southern Maine
High School Diploma -
Hebron Academy
- CPC, American Academy of Professional Coders, December 2005 – Present
- Emergency Medical Technician (EMT), September 2017 - Present
- Certified interior and exterior Firefighter, November 2015 - Present
- Medical Terminology Course, CMMC School of Nursing, August 2003
- Citizen's Police Academy, October 2008 (VIPS - Volunteer in Police Service member) Advanced class; June 2012
- CERT (Community Emergency Response Team), Maine Emergency Response, April 2010
- Certified Funeral Attendant, August 2019 - Present
- Certified Real Estate Agent, PinePoint Realty -August 2023-Present
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