Michele Rouette
Livingston,NJ
Summary
PIP Paralegal with advanced knowledge in Medicare and Medicaid compliance, specializing in lien negotiation and dispute resolution. Demonstrated success in managing complex claims and ensuring adherence to regulatory guidelines.
Overview
27
27
years of professional experience
Work History
CMS/HMS Lien Resolution & PIP Paralegal
Law Offices Rosemarie Arnold
Fort Lee, New Jersey
01.2023 - Current
- Oversee the Medicare and Medicaid Lien Department by managing workflows, compliance protocols, and resolution strategies across all personal injury and medical malpractice cases
- Manage lien resolution efforts for 1600+ NJ/NY CMS/HMS claims
- Conduct legal research for attorneys related to complex Medicare/Medicaid lien issues
- Draft Medicare/Medicaid claim disputes and subsequent appeals
- Dispute and negotiate final liens for all NJ/NY CMS and HMS estate recovery claims in compliance with state-specific protocols
- Draft complex personal injury lien compromise requests for NY Dept of Social Services related to Cash Assistance & Medicaid liens
- Interview clients to obtain treatment updates and medical histories
- Summarize medical records and develop chronological treatment histories to support lien disputes, settlement negotiations, and Medicare Set Aside (MSA) report preparation
- Collaborate with hospital billing and risk management teams when necessary to resolve complex billing dispute issues that affect lien accuracy and compliance
- Coordinate with Medicare and Medicaid to correct conditional payment errors, prevent duplicative billing, and reduce lien exposure
- Ensure full compliance with CMS guidelines and HIPPA authorization protocols
- Attend CMS Medicare/Personal Injury Lien Resolution webinars regularly to stay current on regulatory updates and update firm on ever changing guidelines
- Collaborate with attorneys/paralegals to resolve PIP-related payment discrepancies that impact Medicare and Medicaid lien exposure
- Work with PIP adjusters and medical providers to resolve their billing issues in order to ensure reimbursement, reduce lien exposure, resolve coordination of benefits conflicts and prevent improper billing improper billing
- Identify and correct cases where hospitals bill Medicare or Medicaid before exhausting PIP benefits, preventing inflated lien ledgers and reimbursement complications
- Entrusted with client retention responsibilities for high value accounts, initiating strategic phone outreach to reinforce client satisfaction
- Create systems to improve the firm's intake processes and insurance data collection processes
- Developed a comprehensive compliance checklist for firm-wide oversight of MSA vendor activities and continuously work with vendor on all ongoing MSA report preparation efforts
- Coordinate with firm's internal accounting department to ensure payment of all final CMS and HMS final liens
- Communicate with CMS Medicare and HMS Medicaid on a daily basis via phone, email and fax to resolve all lien related issues and ensure payment/satisfaction of all final liens.
- Maintain monthly lien status tracking and persistent agency follow-up
Mass Tort Litigation Paralegal
Mazie Slater Katz & Freeman
Roseland, NJ
10.2018 - 01.2023
- Managed preparation for 300+ complex litigation matters in medical product liability mass tort department
- Drafted case settlement breakdowns to facilitate resolution processes
- Reviewed and summarized medical records, updating chronological treatment history for Trial Master Judge
- Communicated with Medicare, Medicaid, and private insurers to resolve lien issues and draft dispute letters
- Ensured compliance with CMS Medicare and HMS Medicaid regulations and requirements
- Drafted HIPAA authorization documents per state and federal laws
- Coordinated client intake and conducted thorough case evaluations
- Organized case information within company database to streamline access
Investment Broker Assistant
Summit Equities Inc.
Parsippany, NJ
03.2015 - 09.2018
- Assist broker with daily administrative operations
- Prepare financial summaries and investment proposals
- Process applications for new business
- Manage incoming assets
- Handle customer service requests
- Monitor required minimum distribution deadlines
- Maintain schedules and electronic filing systems
- Coordinate and schedule medical exams required for clients applying for high-value life insurance policies, ensuring compliance with underwriting requirements and facilitating the application process
- Prepare detailed life insurance illustration proposals and obtain competitive life insurance quotes to support broker sales efforts
Legal Assistant Employment Labor Law Defense
Buchanan Ingersoll & Rooney
Newark, NJ
10.2005 - 02.2009
- Prepare attorney correspondence and expense reports
- Draft various legal documents
- Reconcile attorney trust accounts
- Manage the Legal Key electronic filing system
- Manage multi-line front desk switchboard
- Scheduling
- Transcription and timekeeping
- Scan in and print out large sets of documents for various litigation support efforts
- Bate stamping
- Manage attorney calendar
- Court filings
- Collaborate with all firm vendors and couriers
DCA Legalized Games of Chance Control Commission
State of New Jersey
Newark, NJ
04.1999 - 06.2005
- Register non profit organizations to conduct games of chance for charitable purposes
- Heavy client interactions via phone, fax, and mail to assist in the initial affidavit and application and renewal application process
- Prepare and distribute monthly executive meeting materials, reports and board meeting minutes
- Research all consumer complaints and prepare case for executive officer and commission review
- Communicate complaint disposition between the complainant and organization
- Prepare reports of operations after every non-profit gaming event
- Daily processing of all incoming application fees
- Maintain filing system and database
- Coordinate mass mailings
- Oversee and process all biennial renewal applications
- Assist all educational and religious non-profit organizations to obtain the 501 (c)(3) charity id number necessary to register with the NJ DCA LGGGG
Education
Certificate - Online Certified Paralegal Program
County College of Morris
Randolph, NJ06-2022
Certificate Program Accounting, Computer and Business Applications - Business Operations
Rets School of Business
Nutley, NJ12-2010
Some College (No Degree) - Psychology 80 Credits To Date
Rutgers University
Newark, NJ05-2009
Skills
- Proficient in Legal and Medical Terminology
- Work with ICD-10-CM Codes to Identify/Categorize Medical Diagnoses and Treatments
- Medicare and Medicaid Compliance Knowledge
- Personal Injury Medical Lien Negotiation
- HIPPA Compliance Knowledge
- Testamentary Document Compliance Knowledge and Handling for Personal Injury Estate Cases
- Claims Processing
- Billing Dispute Resolution
- Medical Record Summarization
- Legal and Medical Research
- Legal Writing/Professional Report Writing Skills
- Draft and Edit Various Reports, Correspondence and Legal Documents
- Drafting and Preparing Subpoenas
- Pre-Trial Prep Assistance
- Plaintiff Fact Sheet Preparation
- NEOS Case Management Software
- Salesforce
- Quickbooks
- Egnyte
- Legal Key
- Docs Open
- Accounts Receivable
- Type 80 WPM
- MS Office Suite
Timeline
CMS/HMS Lien Resolution & PIP Paralegal
Law Offices Rosemarie Arnold
01.2023 - Current
Mass Tort Litigation Paralegal
Mazie Slater Katz & Freeman
10.2018 - 01.2023
Investment Broker Assistant
Summit Equities Inc.
03.2015 - 09.2018
Legal Assistant Employment Labor Law Defense
Buchanan Ingersoll & Rooney
10.2005 - 02.2009
DCA Legalized Games of Chance Control Commission
State of New Jersey
04.1999 - 06.2005
Certificate - Online Certified Paralegal Program
County College of Morris
Certificate Program Accounting, Computer and Business Applications - Business Operations
Rets School of Business
Some College (No Degree) - Psychology 80 Credits To Date
Rutgers University