Michele Donnell
Williamsport
Summary
Patient-focused, detail-oriented and computer-savvy individual with 12 years of experience in the medical field. Frequently recognized as a self-motivated and organized individual with exceptional time management skills. Dedicated leader eager to join an innovative organization.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Medicare Appeals Specialist
Novitas Solutions
06.2012 - Current
- When presented with a provider or beneficiary appeal for a Medicare Part B claim, a review must be completed to confirm the claim was processed according to Medicare guidelines
- Additional independent research must be conducted using internal resources and government databases to determine if criteria has been met to allow denied medical services or procedures to be overturned and paid.
- As a practice, I review current and new guidelines, policies and procedure when processing. When applicable I submit updates or change requests to improve the flow or enhance them for accuracy and readability.
- I have been selected for special projects related to RAC/935 processing to ensure the inventory is being processed consistently among the designated team. I am actively engaged in the projects, closely reviewing all details associated with our processes, asking questions, offering input and suggestions.
- I was selected to mentor new appeals team members after training and peers that were struggling to meet their performance goal. To effectively provide this service it was necessary to review their quality errors and/or production issues to design a strategic plan.
Education
Medical Billing and Coding -
Bloomsburg University of Pennsylvania
Bloomsburg, Pennsylvania05.2012
Political Science -
Bloomsburg University of Pennsylvania
Bloomsburg, Pennsylvania05.2000
Skills
- Computer Skills
- Customer service
- Time Management
- Organizational Skills
Certification
- Pennsylvania Child Abuse History Certification, 2K673O5HE2
- Pennsylvania Mandated Reporter Training, 203885
Timeline
Medicare Appeals Specialist
Novitas Solutions
06.2012 - Current
Medical Billing and Coding -
Bloomsburg University of Pennsylvania
Political Science -
Bloomsburg University of Pennsylvania
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