Michelle Calvert

=Advanced Level Medial Billing & Coding Specialists, with experience in specialty care services such as, Primary Care, Ophthalmology, Neurosurgery, Sports Medicine, Orthopedics, Podiatry, Rehabilitation; and Behavioral health services. Exceptional knowledge in ambulatory, inpatient, and outpatient claim filing and payment processing, professionally certified in both ICD-10 and CPT Coding. Excellent attention to detail, with consistent and organized best practices, working both insurance and patient accounts. Full knowledge of Federal and State Level HIPPA Compliance, and maintains consistency on updates and changes regarding insurance billing requirements and protocols. Extensive experience working with a wide range of EMR systems such as E-Clinical works, Centricity, EPIC, Revolution and Navicure, Kareo, and Therabill; and provider insurance platforms such as One Health Port and Availity. The ability to lead and build healthy relationships with my team, while meeting and exceeding goals, and making a difference in the community. Demonstrated success in supporting and enhancing revenue cycles for both private and most recently FQHC facilities. Knowledgeable about debt management, collections policies and insurance payments. Good verbal and written communication skills.

Measurable Achievements at NHC

• Successfully onboarded and trained new RCS Team Members; and received my Certification as a Professional Medical Coder to support and solidify my previous medical billing and coding experience of over 5 years collectively.

• Coordinated with the dental clinical team at Canby, as well as my direct team members her in the Revenue Cycle department, in implementing a workflow for generating Good Faith Estimates; targeting our organizational goals to maintain compliance with the No surprises Act. As a result, we have a Team chat solely for Dental and Billing to coordinate tasks, troubleshoot concerns; and to provide and receive updates as needed. In addition, I developed a detailed workflow for myself as the Lead, to streamline the daily generation of workflows for the revenue cycle team, and this has decreased the number of encounters our GFE WQ by 67% as of today; and we forecast this number to grow as our team grows, which will increase opportunities for delegation and team professional development.

• Held and maintained weekly Lead meetings with the Revenue Cycle Team; providing ongoing support with delegated tasks and projects; as well as providing coaching and strategies on achieving both professional & organizational goals.

• Assisted the Revenue Cycle Manager with the allocation of tasks and projects through out the team; while attending regular OCHIN Finance & Administrative meetings to receive regular updates and support on how to improve our departments workflows and troubleshoot any major challenges we may be facing in reaching our departmental and organizational goals. Attending Front Office Lead meetings with members of our clinical team to identify and discuss departmental needs; patient customer service requests and other ways to improve the patient experience and produce results.

• Developed a strong relationship with our outside labs team at Lab Corp; through consistent communication and coordination on patient billing requests and complaints communicated by both our clinical and OBS staff; and maintaining clear and efficient documentation via the Lab Corp Billing Tracker.

• Successfully developed a payer specific modifier coding reference for our coding team to support in major and ongoing OHA & insurance changes, post PHE. This guide was intended to assist in identifying denial trends and keep up with lingering and unclear changes that may have fallen through the cracks while adjusting and fine tuning our billing and coding best practices moving forward.

• Helped our team develop a new Denial Management Project, to maintain consistency with on preferred payer updates and policy changes that directly affect our reimbursement rates as an FQHC, including but not limited to WRAP and APCM reimbursements. To significantly decrease increase insurance denials, as a result to coding errors involving the misuse of modifiers. As well as increase the financial integrity of our organization and promote a stronger provider and patient and provider relationship, by decreasing the number of patient billing complaints.

• Willing To Relocate: Tigard, OR
• Title: Lead Revenue Cycle Specialist, CPC