Michaela Picard
Medicaid claims Analyst
Bend,OR
Summary
Detail-oriented Medicaid Claims Analyst with a proven track record in claims processing, policy interpretation, and compliance assurance. Committed to enhancing operational efficiency and minimizing claim denials.
Overview
13
13
years of professional experience
Work History
Medicaid Claims Analyst 2
Pacificsource
Bend, OR
03.2019 - 06.2026
- Process claims: Review and accurately adjudicate medicaid/medicare claims pended for manual adjudication according to member plan benefits and department policies
- Verify data: Check patient information, procedure/diagnosis codes, billed amounts, and provider data for accuracy
- Determine coverage: Apply benefit and policy provisions, contract terms, and claims processing guidelines to decide coverage
- Use documentation tools: Record pertinent claims/member information in the Notes system
- Manage set-aside claims: Review and release claims set-aside for further action in a timely manner
Medical Coding Specialist 1
Desert Orthopedics
Bend, OR
10.2017 - 03.2018
- Collaborated with healthcare providers to clarify diagnoses and procedures for precise coding.
- Analyzed medical documentation to ensure accurate coding and compliance with industry standards.
- Reviewed and updated coding policies to align with changes in regulations and payer requirements.
- Utilized advanced coding software to enhance productivity and maintain high levels of data integrity.
- Collaborated with healthcare providers to clarify ambiguous or incomplete documentation, resulting in more precise medical codes.
- Reduced claim denials by consistently ensuring accurate and compliant coding practices in line with regulatory standards.
- Maintained strict adherence to HIPAA regulations by protecting confidential patient information during the coding process.
- Charge entry, editing correct coding and claims scrubbing
- Ongoing education of new coding rules and regulations
Medical Front Office Receptionist
Desert Orthopedics
Bend, OR
05.2015 - 10.2017
- Managed patient check-in and check-out processes, ensuring smooth clinic operations.
- Coordinated appointment scheduling, optimizing provider calendars for efficiency.
- Handled insurance verification and pre-authorization to expedite patient care.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details.
- Checked patient insurance, demographic, and health history to keep information current.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Implemented streamlined check-out procedures, ensuring that patients received proper documentation and follow-up appointment scheduling.
- Demonstrated adaptability by quickly learning new software programs and adapting to changes in office policies or procedures as needed.
Medical Records Specialist
Desert Orthopedics
Bend, OR
05.2013 - 05.2015
- Conducted regular audits of medical records to verify accuracy and completeness, enhancing overall data integrity.
- Managed electronic medical records system to ensure accurate patient data retrieval and documentation.
- Coordinate with health care providers, patients, attorneys, third party payers and subpoenas to release information
- Process requests for release of information
- Interact with patients in person and by telephone, to obtain appropriate authorization
- Distribute incoming information requests to appropriate personnel within the clinic
Education
Associate of Applied Science - Health Information Management
Central Oregon Community College
Bend, OR09.2009
Skills
- Claims
- Claims analysis
- Claims processing
- Claims evaluation
- Policy interpretation
- Medical coding standards
- MS Office proficiency
- Critical thinking
- Decision-making
- Problem-solving
- Attention to detail
- Teamwork and collaboration
Timeline
Medicaid Claims Analyst 2
Pacificsource
03.2019 - 06.2026
Medical Coding Specialist 1
Desert Orthopedics
10.2017 - 03.2018
Medical Front Office Receptionist
Desert Orthopedics
05.2015 - 10.2017
Medical Records Specialist
Desert Orthopedics
05.2013 - 05.2015
Associate of Applied Science - Health Information Management
Central Oregon Community College