Michelle Guillen
El Paso,TX
Summary
Dedicated healthcare management professional with a proven track record in insurance verification, medical billing, and operational excellence. Demonstrated leadership at Fresenius Medical Care Holdings Inc., driving a 95% reduction in payment errors through meticulous invoice processing. Skilled in problem-solving, organization, and delivering exceptional customer service.
Overview
19
19
years of professional experience
Work History
Reimbursement Case Manager
CareMetx, LLC
01.2022 - Current
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Prioritized workload efficiently to manage high volume caseloads without compromising attention to detail or quality of work.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the reimbursement process.
- Coordinated with insurance providers to verify customer's policy benefits.
- Trained new employees.
Insurance Verification Specialist
Cornerstone Staffing, Inc. Temporary Contract Position
11.2021 - 06.2022
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Collaborated with team members to resolve discrepancies in insurance verification.
Covid 19 Vaccine Scheduler
Omni Interactions
02.2021 - 02.2022
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Assisted clients with locating and signing up for COVID-19 tests based.
- Provided referrals to local clinics, urgent care centers and hospitals for patients based on query responses.
- Maintained compassionate demeanor throughout patient and customer interactions to ameliorate stressful situations.
- Maintained high levels of customer satisfaction through diligent scheduling coordination, ensuring all deliverables were met within agreed timeframes.
Team Lead
Anywhere Works
08.2019 - 05.2021
- Directed and supervised team of 25 engaged in Excellent Customer Service and training development.
- Assisted in recruitment to build team of top performers.
- Trained new team members by relaying information on company procedures and safety requirements.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Coached team members in techniques necessary to complete job tasks.
- Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
Insurance Verification Specialist
Altomar Home Healthcare
01.2011 - 10.2015
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Developed strong relationships with insurance representatives, facilitating smooth communication channels for resolving inquiries or disputes.
- Provided exceptional customer service when responding to patient inquiries about reimbursement status and procedures.
- Billed and collected for claims submitted on clients' behalf totaling $375,00.00 on back dated claims.
- Enhanced the overall financial performance of the organization by diligently monitoring outstanding claims and following up on overdue payments.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Employed clinical and billing codes expertise to correct billing inconsistencies.
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
- Audited and corrected billing and posting documents for accuracy.
- Verified accuracy of accounts payable payments, resulting in 95% reduction in payment errors.
Regional Manager
Fresenius Medical Care Holdings Inc.
11.2005 - 10.2011
- Enhanced team performance by providing regular coaching, training, and performance feedback to staff members.
- Established and maintained operational standards for 26 locations.
- Mentored and developed high-potential employees for leadership roles through individualized career development plans and opportunities for growth.
- Managed P&L to decrease discrepancies and retain timely and under-budget project completion.
- Verified timekeeping records and handled any discrepancies with employees.
- Supported business development efforts by preparing sales materials, proposals, and marketing collateral tailored to client needs or events in the region.
- Boosted team productivity by providing administrative support and managing day-to-day operations.
- Organized high-level meetings and events to foster collaboration between regional departments.
- Processed travel expenses and reimbursements for executive team and senior management group.
Education
Bachelor of Science - Business Health Administration
Pima Medical Institute
Tucson, AZ06.2026
Associate of Applied Science - Billing And Coding
Vista College
Richardson, TX08.2018
Skills
- Problem-Solving
- Case Management
- Organization and Multitasking
- EMR / EHR
- Medical coding knowledge
- Medical Billing Expertise
- Microsoft Office
- Customer Service
Timeline
Reimbursement Case Manager
CareMetx, LLC
01.2022 - Current
Insurance Verification Specialist
Cornerstone Staffing, Inc. Temporary Contract Position
11.2021 - 06.2022
Covid 19 Vaccine Scheduler
Omni Interactions
02.2021 - 02.2022
Team Lead
Anywhere Works
08.2019 - 05.2021
Insurance Verification Specialist
Altomar Home Healthcare
01.2011 - 10.2015
Regional Manager
Fresenius Medical Care Holdings Inc.
11.2005 - 10.2011
Bachelor of Science - Business Health Administration
Pima Medical Institute
Associate of Applied Science - Billing And Coding
Vista College
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