Michael McGuire
Aurora,CO
Summary
Accomplished in maximizing team knowledge and performance. Well-versed in working with department leaders to improve training programs and outcomes. Hardworking and thorough with strengths in conflict management and relationship building.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Insurance Verification Manager (RAVE)
Childrens Hospital Colorado
Aurora, Colorado
06.2022 - Current
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Established team priorities, maintained schedules and monitored performance.
- Defined clear targets and objectives and communicated to other team members.
- Managed team of 80 referral, authorization, verification and eligibility employees.
- Worked closely with stakeholders to implement enhanced processes.
Patient Financial Services Manager
Kaiser Permanente
Denver, Colorado
01.2022 - 06.2022
- Complied with established internal controls and policies.
- Established and enforced internal controls, workflows and policies for tracking, reconciling and reporting on accounting activities.
- Checked payroll, vendor payments, commissions and other accounting disbursements for accuracy and compliance.
- Implement revenue cycle business plans, taking accountability for results.
Senior Contract Manager
Kaiser Permanente
Denver, CO
01.2021 - 01.2022
- Mitigated business risks by analyzing contracts potential impacts and avoiding unfavorable terms.
- Maintain Contract Manager database including contract, vendor and customer information.
- Analyze perspective contract agreements and propose terms.
- Established key contract provisions with medical group, department leaders and staff.
- Negotiated financial and operational issues with providers and practitioners.
National Payment Integrity Supervisor
Kaiser Permanente
Englewood, CO
10.2019 - 01.2021
- Provided Leadership and Support for Senior Auditors.
- Conducted evaluations and reviews for 10 employees.
- Managed special projects to increase revenue and customer numbers while reducing costs and streamlining processes.
- Coached and mentored 10 staff members through constructive feedback to develop long-term career goals.
- Provided ongoing training and analysis to address staff needs.
- Inventory Management for 7 regions.
Claims Processing Supervisor
Kaiser Permanente
Englewood, CO
03.2018 - 10.2019
- Transformed work area by increasing production, reducing turnover, eliminating waste and enhancing quality.
- Trained, mentored and supported high-performing team, providing regular performance review, feedback and coaching in deficient areas.
- Met other supervisors and business leaders to plan and guide workflow and operations.
- Supervised, trained and evaluated 13 employees in Healthcare industry.
- Led Member Call Back Pilot, reducing turnaround times in claims operations.
Quality Auditor
Kaiser Permanente
Englewood, CO
12.2016 - 03.2018
- Investigated and identified quality issues to uncover root causes and explore potential corrective actions.
- Used consistent and fair assessment procedures to achieve optimal audit results.
- Analyzed issues and recommended corrective actions to improve final results.
Claims Examiner
Kaiser Permanente
Englewood, CO
06.2016 - 12.2016
- Paid and processed claims within designated authority level.
- Provider and Member Appeal / Dispute Resolution.
- Thorough knowledge of policies, practices and health connect systems.
Medical Billing Specialist
HRH Community Healthcare
Beacon, NY
10.2015 - 05.2016
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Posted and adjusted payments from insurance companies.
- Located errors and promptly refiled rejected claims.
- Precisely evaluated and verified benefits and eligibility.
Medical Billing Specialist
Paladina Health LLC
Denver, CO
01.2014 - 10.2015
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Posted and adjusted payments from members.
- Located errors and promptly refiled rejected claims.
- Precisely evaluated and verified benefits and eligibility.
Legal Assistant
Machol & Johannes LLC
Denver, CO
08.2010 - 01.2014
- Provider communication to discuss payment and settlement per contract.
- Composed correspondence and stipulations with consumers.
- Prepare documentation and follow up on lawsuits for seven attorneys.
- Payment plan and settlement negotiation for contracted healthcare providers.
Healthcare Account Specialist
Medicaid Colorado
Aurora, CO
07.2007 - 08.2010
- Monthly preparation and disbursement of provider payment.
- Claims quality auditing and fee schedule interpretation.
- Maintained department standards by monitoring quality metrics.
Education
Computer Science
University of Colorado Denver
Aurora, COHigh School Diploma -
Glen Mills High School
Concordville, PA06.2000
Skills
- Leadership, Training and Coaching
- Relationship and Team Building
- Contract Negotiation
- Performance Improvement
- Presentations and Demonstrations
- Compliance Standards
- Project Implementation
- Payroll Processing
- Quality Auditing
- Claims Processing
Certification
Epic AP Claims and Contracts, 2020
Awards
Epic Scholarship Recipient, 2020
People Matter I Matter Recipient, 2020
Timeline
Insurance Verification Manager (RAVE)
Childrens Hospital Colorado
06.2022 - Current
Patient Financial Services Manager
Kaiser Permanente
01.2022 - 06.2022
Senior Contract Manager
Kaiser Permanente
01.2021 - 01.2022
National Payment Integrity Supervisor
Kaiser Permanente
10.2019 - 01.2021
Claims Processing Supervisor
Kaiser Permanente
03.2018 - 10.2019
Quality Auditor
Kaiser Permanente
12.2016 - 03.2018
Claims Examiner
Kaiser Permanente
06.2016 - 12.2016
Medical Billing Specialist
HRH Community Healthcare
10.2015 - 05.2016
Medical Billing Specialist
Paladina Health LLC
01.2014 - 10.2015
Legal Assistant
Machol & Johannes LLC
08.2010 - 01.2014
Healthcare Account Specialist
Medicaid Colorado
07.2007 - 08.2010
Computer Science
University of Colorado Denver
High School Diploma -
Glen Mills High School
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