Michelle Kahler
Abington,MA
Summary
Dynamic Compliance Officer and Medical Claims Processor with a proven track record at Harvard Pilgrim Healthcare. Excelled in processing high-volume medical claims and maintaining strict compliance with HIPAA regulations. Demonstrated expertise in redacting sensitive information and leading teams to achieve quality results. Skilled in effective communication and problem resolution, ensuring policy adherence and operational efficiency.
Overview
27
27
years of professional experience
Work History
Compliance Officer
Commonwealth of Massachusetts
11.2007 - Current
- To maintain and upload Investigation Reports, Intakes, Initial Responses and CD's and Photo's into Docstar software, upload investigation files and any corresponding documents.
- To accurately and thoroughly redact abuse reports and/or investigation reports via Adobe Acrobat. Redacting all CORI from reports for other State Agency's and then sending the report to that Agency via email. Sending out Record Requests within the 10 business days that is alloted for sending out to requestors.
Medical Claims Processor and Team Leader
Harvard Pilgrim Healthcare
10.1997 - 06.2005
- Processed high volumes of 60 + medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Paid or denied medical claims based upon established claims processing criteria.
- Provided support in weekly team meetings effecting quality results
- Assigned daily work to processors
Education
Legal Office Administration
Massasoit Community College
Brockton, MASkills
- Extensive Office Experience
- Excellent interpersonal skills
- Detail-Oriented Organizational Abilities
- Production and detail oriented
- Advanced Skills in Word and Excel
- Skilled at Prioritizing Concurrent Responsibilities
Timeline
Compliance Officer
Commonwealth of Massachusetts
11.2007 - Current
Medical Claims Processor and Team Leader
Harvard Pilgrim Healthcare
10.1997 - 06.2005
Legal Office Administration
Massasoit Community College
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