MICHELLE EVE
KALAMAZOO,MI
Summary
Results-oriented Reimbursement Specialist with experience in coding and abstracting patient medical records in compliance with industry standards. Demonstrates exceptional accuracy and organizational skills, contributing to streamlined processes and improved operational efficiency. Recognized for effective communication and a proactive approach to problem-solving, facilitating seamless interactions with healthcare teams. Aiming to leverage expertise in reimbursement strategies to enhance patient access and financial performance.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Coding Reimbursement Coordinator
CLEVELAND CLINIC FOUNDATION
Cleveland, OH
05.2024 - Current
- Contributed to a 12% reduction in the volume of the assigned work queue within the first 6 months of hire.
- Researched front-end rejections and claim denials, investigating problems to appeal neurology specialty claims in a multi-state provider network.
- Gained comprehensive understanding of various state payer rules for managing large-scale denial cases efficiently.
- Drafted reconsideration and appeal documents based on CMS, AMA, and specific payer guidelines for multiple denial scenarios, and submitted them to the necessary parties.
- Identified opportunities for process improvements related to coding reimbursements, leading to the development of QRGs based on findings.
- Collaborated with other departments to resolve coding issues or discrepancies.
- Maintained up-to-date knowledge of applicable laws, regulations, practices, and trends in the healthcare industry.
Denial Resolution Specialist
University of Michigan Health-Sparrow
07.2023 - 05.2024
- Utilized professional expertise in billing and coding for the effective resolution of complex claims, while increasing productivity through the optimization and streamlining of Epic work queues.
- Developed reports summarizing coding trends, revenue cycles, and denials to enhance the development and utilization of front-end coding edits to reduce coding denials.
- Verified the correct application of coding standards to multi-specialty provider records.
- Developed resources to support new departmental procedures to streamline workflow.
- Worked alongside various departments to generate query workflow and Inbasket templates by developing provider messaging guidelines.
Coder Associate
Corewell Health
01.2022 - 01.2023
- Optimized management of work queues in key care sectors.
- Consistently met and exceeded department productivity and accuracy goals at or above 95%.
- Conducted daily reviews of provider documentation for accurate CPT/ICD-10 code selection, while ensuring compliance with coding, billing, and facility guidelines.
- Maintained the integrity of captured financial charges by collaborating with medical staff to clarify diagnoses or treatments when necessary.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Participated in continuing education programs related to medical coding procedures.
- Educated providers to prevent future documentation errors.
Coding Specialist I
Bronson Healthcare Group
01.2021 - 01.2022
- Analyzed multi-specialty provider documentation to identify appropriate diagnostic and procedural codes, while ensuring compliance with current CPT and ICD-10 guidelines.
- Developed a thorough understanding of CPT and HCPCS codes and modifiers used in the healthcare industry.
- Utilized encoder software to ensure accurate diagnosis and procedural code selection as well as appropriate sequencing of diagnosis codes according to AMA and payer guidelines.
- Collaborated on special project efforts to increase revenue by capturing post-operative nerve block services.
- Maintained a high accuracy rate on the daily production of completed reviews while recognizing and appropriately escalating problematic trends.
Charge Analyst
Bronson Healthcare Group
01.2019 - 01.2021
- Developed a thorough understanding of CPT and HCPCS codes and modifiers used in the healthcare industry.
- Evaluated and interpreted medical reports and clinical data to capture ED and observation charges, and appropriately apply ICD, CPT, and HCPCS codes, while ensuring revenue integrity.
- Entered coded data into electronic health record (EHR) systems.
- Identified issues based on the analysis of documentation that were affecting the ability to charge for services, and reported to Revenue Integrity and management as needed.
- Maintained updated knowledge of coding requirements, which included continuing education and certification renewal.
- Participated in coding team meetings to discuss challenges and best practices.
Data Integrity Specialist
Bronson Healthcare Group
01.2017 - 01.2019
- Monitored and maintained the reliability of medical record data by performing validation of demographic changes, examining patient overlaps, document corrections, and merging of duplicate patient records.
- Responsible for maintaining a strong working knowledge of electronic medical records and other computer-based programs utilized to perform job functions (Epic, OnBase).
- Analyzed documentation to identify issues affecting service chargeability.
- Ensured timely correction of errors while validating the accuracy of all identifiers within a medical record.
- Maintained confidentiality and integrity of patient data.
Patient Representative-Outpatient Testing/Bronson Center for Women
Bronson Healthcare Group
01.2014 - 01.2017
- Registered scheduled and walk-in appointments for multiple departments by collecting and verifying demographic, insurance, and billing information
- Provided patients with financial information, including account balance details and price estimates, to resolve patient financial issues, negotiate payment arrangements, and collect payments.
- Precepted new hire staff on a regular basis to ensure accurate performance of all aspects of the job role, including registration, application of billing and coding knowledge, collection of payments, and general department and facility guidelines.
- Reviewed account information to confirm patient and insurance information is accurate and complete. Entered patient insurance, demographic and health information into software and confirmed records.
- Handled incoming calls and directed callers to appropriate department or employee.
- Answered questions and fulfilled requests with friendly and knowledgeable service.
Patient Representative-Emergency Department
Bronson Healthcare Group
01.2013 - 01.2014
- Entered patient data into electronic medical record system accurately and efficiently to perform registration of walk-in and ambulance patients in a high-stress, fast paced environment.
- Coordinated bedside registration with clinical staff to accurately collect patient demographic information, verify insurance coverage, and update records as necessary.
- Routinely assisted with outpatient testing registration during after-hours, including the application of coding and billing guidelines for ordered testing.
- Maintained current knowledge of billing and coding requirements, and applied these to workflow.
- Provided patients with financial information, including account balance details, negotiated payment arrangements, and collected patient payments.
- Precepted new hire staff on a regular basis to ensure accurate performance of all aspects of the job role, including registration, application of billing and coding knowledge, collection of payments, and general department and facility guidelines.
- Coordinated with clinical staff to ensure timely care for patients, including those who are critically ill.
Customer Service Representative/Authorization Specialist
Accretive Health
01.2011 - 01.2012
- Managed a high call volume concerning medical billing inquiries for major healthcare institutions, and performed escalation of issues to supervisors as needed.
- Ensured compliance with coding and authorization processes by working with varied offices and payers.
- Informed customers about billing procedures, processed payments, and provided payment option setup assistance. Maintained detailed records of customer interactions, transactions and comments for future reference.
- Resolved complex billing problems by working with other departments to provide solutions that meet customer needs.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
Unit Clerk-Emergency Department
Bronson Healthcare Group
01.2011 - 12.2011
- Prepared discharge summaries following completion of a patient's stay in the facility.
- Acted as liaison between patients and family members and healthcare providers.
- Assisted in the preparation of patient charts and medical records.
- Performed data entry into an electronic health record system.
- Ordered office supplies, equipment, and other materials as needed.
- Provided support to physicians and nursing staff with administrative tasks.
- Scanned documents into computer databases for storage purposes.
- Answered telephone calls, responded to requests for information and routed callers to correct personnel or departments.
- Assisted nursing and medical staff in clerical duties to support patient care.
- Answered phones to transfer calls or relay messages to patients or staff.
- Prepared charts for outpatient and inpatient services.
- Demonstrated knowledge in medical terminology to accurately transcribe physician orders.
- Recorded patient data in permanent records while maintaining HIPAA compliance and internal standards to protect individual medical information.
- Screened calls and collected messages for unit personnel to promote team efficiency.
Patient Registration-Emergency Department
Orlando Regional Medical Center
01.2010 - 12.2010
- Registered walk-in and ambulance patients in a high-stress, high-volume environment, while updating patient information in the database regularly to ensure the accuracy of records.
- Verified insurance and collected critical data elements to properly identify and bill patients.
- Registered patients using proper data entry procedures and fully compliant ICD-10 and CPT codes.
- Adapted to facility processes for bedside registration to accurately capture demographics, insurance, and visit-related information for insurance reporting purposes.
- Worked collaboratively with other departments within the organization to ensure seamless operations.
- Educated patients on their rights as well as hospital policies related to care delivery.
- Negotiated payment arrangements and collected payments efficiently by providing comprehensive financial data.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Followed up on outstanding balances due from insurance companies or patients.
Patient Representative-Emergency Department
Bronson Healthcare Group
01.2008 - 01.2010
- Performed registration of walk-in and ambulance patients in a high-stress environment.
- Coordinated bedside registration with clinical staff to accurately capture demographics, insurance, and visit-related information for insurance reporting purposes.
- Routinely assisted with outpatient testing registration during after-hours, including the application of coding and billing guidelines for ordered testing.
- Maintained current knowledge of billing and coding requirements, and applied these to workflow.
- Provided patients with financial information, including account balance details and price estimates, to resolve patient financial issues, negotiate payment arrangements, and collect payments.
- Precepted new hire staff on a regular basis to ensure accurate performance of all aspects of the job role, including registration, application of billing and coding knowledge, collection of payments, and general department and facility guidelines.
Unit Clerk-Emergency Department
Bronson Healthcare Group
01.2006 - 01.2008
- Performed clerical and reception services including answering of multi-line phone system and patient call lights, preparation of patient discharge paperwork, entering of physician orders into HMED/Epic systems, contacting on-call providers
- Coordinated delivery of care including initiating trauma activations and need for urgent respiratory assistance, requesting of blood products and medications while ensuring timely receipt by clinical staff, and setting up necessary patient transport with multiple clinical staff members as well as internal and external departments
- Managed multiple unit communication systems (e.g
- Multi-line phone system, nurse call system, hospital information systems) and relayed information to clinical staff
- Assisted in maintaining supplies, equipment, and overall unit
Education
High School Diploma -
Kalamazoo Central High School
Kalamazoo, MI06-2002
Skills
- Epic
- OnBase
- 3M
- Optum
- Craneware
- ICD-10 Coding Experience
- Microsoft Office Proficiency
- HIPAA regulation knowledge
- Cross-jurisdictional Medicare/Medicaid knowledge
- Healthcare Coding and Billing regulations
- Analytical thinking and high quality assurance
- Deadline management under pressure
- Strong organizational skills
- Successful claims processing
- Proficient verbal and written communication
- Insurance verification and benefits coordination
Certification
- CPC-2020 AAPC
- CDEO-2024 (In progress) AAPC
- Advanced ICD-10-2024 (In progress) AAPC
Affiliations
- AAPC Member Development Officer Kalamazoo Chapter-2024-2025
Accomplishments
- Recipient of multiple caregiver recognitions for excellence in performance and impact in current and previous roles.
References
References available upon request.
Timeline
Coding Reimbursement Coordinator
CLEVELAND CLINIC FOUNDATION
05.2024 - Current
Denial Resolution Specialist
University of Michigan Health-Sparrow
07.2023 - 05.2024
Coder Associate
Corewell Health
01.2022 - 01.2023
Coding Specialist I
Bronson Healthcare Group
01.2021 - 01.2022
Charge Analyst
Bronson Healthcare Group
01.2019 - 01.2021
Data Integrity Specialist
Bronson Healthcare Group
01.2017 - 01.2019
Patient Representative-Outpatient Testing/Bronson Center for Women
Bronson Healthcare Group
01.2014 - 01.2017
Patient Representative-Emergency Department
Bronson Healthcare Group
01.2013 - 01.2014
Customer Service Representative/Authorization Specialist
Accretive Health
01.2011 - 01.2012
Unit Clerk-Emergency Department
Bronson Healthcare Group
01.2011 - 12.2011
Patient Registration-Emergency Department
Orlando Regional Medical Center
01.2010 - 12.2010
Patient Representative-Emergency Department
Bronson Healthcare Group
01.2008 - 01.2010
Unit Clerk-Emergency Department
Bronson Healthcare Group
01.2006 - 01.2008
High School Diploma -
Kalamazoo Central High School
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