Michelle Hightower
McKinney,TX
Summary
Experienced Reimbursement Specialist with 22 years of healthcare revenue cycle management experience. Seeking a Reimbursement Specialist III role. Demonstrated expertise at Xtendhealthcare and Steward Health Care in payer reimbursement, contract analysis, and system auditing for underpayments. Proven track record in leading recovery projects, managing appeals, and ensuring compliance with payer contracts.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Reimbursement Specialist 3
Xtendhealthcare-CorroHealth
12.2021 - Current
- Oversee the analysis and reconciliation of accounts to ensure accurate and timely healthcare reimbursement for services rendered, maintaining compliance with industry regulations and XtendHealthcare policies.
Revenue Cycle Associate
Steward Health Care
07.2021 - Current
- Apply contract modeling software to accurately interpret and implement reimbursement logic.
- Identify underpayments through comprehensive audits of system functionality and operational assessments.
- Analyze reimbursement and claims details to uncover opportunities for optimizing revenue.
- Manage recovery projects by conducting retrospective analyses and leading teams to execute the necessary steps for reclaiming revenue.
Senior Reimbursement Coordinator
Amerisource-US Bioservices
11.2017 - 07.2020
- Analyzed and processed appeals and denials for insurance claims, ensuring resolutions met company and regulatory standards.
- Collaborated with the billing department to confirm claims compliance with insurance payer requirements and partnered with contracting to verify accurate charge bookings and contract-based payments.
- Reviewed payer contracts diligently, adjusting accounts for underpayments and managing credit balances and refunds on a weekly basis.
AR Specialist
Conifer Health Care
10.2015 - 10.2017
- Managed Medicare and third-party account follow-ups, ensuring timely and accurate resolution of refunds and credit discrepancies.
- Conducted thorough review and research of denials and inadequate payments, successfully appealing incorrect decisions to optimize revenue retention.
- Processed all incoming correspondence and addressed payer rejections, maintaining clear and effective communication to uphold account integrity.
Special Projects - Billing and Collections
Diversified Healthcare
08.2005 - 10.2015
- Developed and implemented billing and coding protocols, ensuring compliance with state policy and procedures across various claim types including workers’ compensation, commercial, Medicare, Medicaid, and third-party claims.
- Conducted client training sessions on state policy and procedures, enhancing their understanding and ability to navigate complex healthcare billing environments.
- Monitored and evaluated staff performance in billing and collections, leading to improved efficiency and accuracy in employee production.
Director of Reimbursement
Hunt County Mental Health Retardation
01.2002 - 01.2005
- Managed compliance with managed care contracts to maintain clean claims, contributing to a low rate of lost charges and ensured adherence to productivity performance guidelines for staff efficiency.
- Collaborated with MIS department to streamline electronic billing and collections, and partnered with service units to educate on documentation for authorization and service delivery, enhancing revenue tracking and issue resolution.
- Conducted internal reviews to align with state performance contracts, assisted with fiscal revenue projections, and facilitated center enrollment with commercial plans and PPOs, ensuring policy adherence and operational efficiency.
Billing Coordinator (Cardiology & Internal Medicine)
All Medical Professional (Healthcare Financial)
01.2001 - 01.2002
- Conducted comprehensive on-site audits and summarized weekly financial data to identify and address discrepancies in accounts receivable, ensuring accuracy and regulatory compliance.
- Coordinated and executed staff training programs based on determined needs, contributing to the seamless implementation of new financial systems and maintaining up-to-date payer information.
Medical Collections/Front Office/Surgery Scheduler
Present North Texas Obstetrics & Gynecology
01.2001 - 01.2001
- Streamlined surgery scheduling and insurance preauthorization processes, ensuring accurate billing and timely collections, while also maintaining comprehensive records of payer communications and code utilization.
- Enhanced front office efficiency by training staff, assisting with patient inquiries, and contributing to the development and management of departmental budgets and compliance guidelines.
Education
Bachelor's - Business Management
Dallas Baptist University
06.2025
Medical Billing & Coding & Health Information
Richland Jr College
Richland, TX01.2000
BA - Music (Vocal)
University of New York
New York City, NY01.1984
General/Music
Art's High School
Newark, New Jersey01.1980
Skills
- 11 Years of Collections (Medical, Commercial & Retail)
- 10 Years of Medical Billing (Workers Comp, Medicaid, Medicare, Managed Care)
- 10 Years of a/R, Payment Posting
- 6 Years of Management/Director Experience
- Computer Literate (Win2000, Excel, Quicken, Word, Lytec, Access, Millsbrook, Medical Manager, Physician Office Management, Medic, Unisys, TDH Connect (Medicaid, Medicare, BCBS Online/Electric, Facts II, IServ), CMS-FSS, Cubs, Citrix, NoVo Logix)
- 6 Years of Front Office (Med Hall, Assist Doctor, Scheduling, Customer Service)
- 8 Years of Credentialing, Resolving Payer Problems, Resolving Reimbursement Problems
- 8 Years in Managing a Multi-Specialty Practice (Family Practice, Workers Comp, Physical Therapy, Orthopedic, Diagnostic Testing, Chiropractic, Neonatologist, Pediatric, Ob/Gyn, Behavioral Health)
- 4 Years of Electronic Billing (Medical Manager, Medic, TDH Connect, Thin, Pro 32)
Certification
- Certified Medical Insurance Specialist
- Certified Medical Coder
- Nov 2010
Timeline
Reimbursement Specialist 3
Xtendhealthcare-CorroHealth
12.2021 - Current
Revenue Cycle Associate
Steward Health Care
07.2021 - Current
Senior Reimbursement Coordinator
Amerisource-US Bioservices
11.2017 - 07.2020
AR Specialist
Conifer Health Care
10.2015 - 10.2017
Special Projects - Billing and Collections
Diversified Healthcare
08.2005 - 10.2015
Director of Reimbursement
Hunt County Mental Health Retardation
01.2002 - 01.2005
Billing Coordinator (Cardiology & Internal Medicine)
All Medical Professional (Healthcare Financial)
01.2001 - 01.2002
Medical Collections/Front Office/Surgery Scheduler
Present North Texas Obstetrics & Gynecology
01.2001 - 01.2001
Bachelor's - Business Management
Dallas Baptist University
Medical Billing & Coding & Health Information
Richland Jr College
BA - Music (Vocal)
University of New York
General/Music
Art's High School
Similar Profiles
Deja BushDeja Bush
Patient Communication Representative at CorrohealthPatient Communication Representative at Corrohealth
Loganath ThangarajuLoganath Thangaraju
Senior Executive Medical Coder at CorrohealthSenior Executive Medical Coder at Corrohealth
Gretchen StrickerGretchen Stricker
Medical Coder III at CorroHealth Formerly Xtend Healthcare ServicesMedical Coder III at CorroHealth Formerly Xtend Healthcare Services
Jayda ZastoupilJayda Zastoupil
Dasher at DoorDashDasher at DoorDash
Ammar AhmedAmmar Ahmed
Dell Certified Technician at Dell TechnologiesDell Certified Technician at Dell Technologies