MICHELLE CRONIN
Buffalo,NY
Summary
Reliable team mate with Seven years of experience. Highly organized, self-motivated, detail-oriented, and energetic team player. Ability to multi-task in a fast-paced environment. Open and willing to learn new tasks of the RCM department and Credentialing. Experience with Start-Up culture and fast paced growth.
Overview
7
7
years of professional experience
Work History
NETWORK OPERATIONS ASSOCIATE
SAFERIDE HEALTH
05.2023 - Current
- Contract Adherence and Compliance.
- Responsible for Network Compliance and Credentialing standards across the United States ensuring program SLA's are met and maintained.
- Identified trends and hot spots that need immediate attention to ensure Network Compliance.
- Discussed and executed next steps, solutions and overall impact to the program.
- Conducted internal audits and augmented the audit process to align with external audits.
- Coached and consulted Providers on meeting compliance requirements for Medicare and Medicaid programs.
- Developed compliance process to identify and alert to Providers, Vehicles and Drivers that are at risk of Safety, Insurance and Compliance violations.
- Collaborated with cross-functional teams to develop and implement network upgrades and expansions.
MEDICAL BILLING SPECIALIST
CARBON HEALTH TECHNOLOGIES
04.2021 - 01.2023
- Posted and adjusted payments from insurance companies.
- Identified and resolved patient billing and payment issues.
- Evaluated and verified benefits and eligibility.
- Located errors and promptly refiled rejected claims.
- Completed appropriate claims paperwork, documentation, and system entry.
- Analyzed Explanation of Benefits to verify correct billing of insurance carriers.
- Filed and updated patient information and medical records.
- Liaised between patients, insurance companies, and billing office.
- Communicated with insurance and providers to resolve discrepancies.
- Printed and reviewed monthly patient aging reports and solicited overdue payments.
MEDICAL BILLING SPECIALIST
PROFESSIONAL AMBULANCE BILLING, LLC
02.2017 - 04.2021
- Examined patients' insurance coverage, deductibles, insurance carrier payments, and remaining balances not covered under policies when applicable.
- Liaised between patients, insurance companies, and billing office.
- Posted and adjusted payments from insurance companies.
- Located errors and promptly refiled rejected claims.
- Identified and resolved patient billing and payment issues.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Precisely completed appropriate claims paperwork, documentation, and system entry.
Education
A.A.S MEDICAL - REIMBURSEMENT AND CODING
BRYANT AND STRATTON COLLEGE
BUFFALO, NY2017
Skills
- Commercial and Private Insurance
- Reviewing Patient Information
- Time Management
- Information Confidentiality
- Critical Thinking
- Multitasking and Organization
- Billing and Collections Procedures
- Customer Service
- HIPAA Compliance Certification
- Electronic Health Record Software
- CMS-1500 Billing Forms
- ICD-10
- CPT Code Modifiers
- Data Entry
- Microsoft Excel
Timeline
NETWORK OPERATIONS ASSOCIATE
SAFERIDE HEALTH
05.2023 - Current
MEDICAL BILLING SPECIALIST
CARBON HEALTH TECHNOLOGIES
04.2021 - 01.2023
MEDICAL BILLING SPECIALIST
PROFESSIONAL AMBULANCE BILLING, LLC
02.2017 - 04.2021
A.A.S MEDICAL - REIMBURSEMENT AND CODING
BRYANT AND STRATTON COLLEGE
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