Michelle King-Green
Warwick,RI
Summary
Dynamic and customer-focused healthcare professional with over 29 years of experience in fostering relationships and developing strategic partnerships. Expertise in medical billing, coding, and insurance claims processing complements a self-motivated leadership style that excels in multitasking and project management within fast-paced environments. Recognized for a proactive approach to identifying challenges, optimizing processes, and enhancing team performance while maintaining exceptional communication skills. Committed to driving results that support organizational objectives and elevate the overall client experience through reliability, accuracy, and a detail-oriented focus on financial tasks.
Overview
29
29
years of professional experience
Work History
Electronic Data Interchange Enrollment Manager
Grey Ledge Medical Management
05.2023 - Current
- Led initiatives to streamline EDI workflows, resulting in improved data accuracy.
- Monitored electronic data interchange (EDI) systems for seamless transaction processing.
- Supported company growth by onboarding new trading partners in a timely manner, adhering to their specific requirements.
- Collaborated with cross-functional teams to integrate new EDI applications effectively.
- Resolved EDI-related issues, ensuring timely communications between trading partners.
- Onboarding & Payers: Initiate and complete enrollment for new payers via clearinghouses (e.g., Waystar, Availity, Trizetto, Inovalon, Change, etc).
- EDI Configuration & Maintenance: Prepare and submit applications to set up and maintain EDI transactions such as: 837-Claims, 276/277-Claims Status Inquiry/response,270/271-Eligibility Inquiries/responses, ERA 835 - Remittance Advice, EFT-Electronic Funds Transfers
Credentialing Manager
Grey Ledge Medical Management
06.2021 - Current
- Led credentialing processes for healthcare providers, ensuring compliance with regulatory standards.
- Developed and implemented efficient workflows for credentialing applications and verifications.
- Supervised a team of credentialing specialists, providing mentorship and training to enhance performance.
- Analyzed credentialing data to identify trends, improving accuracy and reducing processing time.
- Collaborated with medical staff and administration to streamline provider onboarding procedures.
- Conducted quality assurance audits on credentialing files to ensure adherence to policies and regulations.
- Coordinated closely with human resources to ensure seamless integration of hiring activities into the overall credentialing process.
- Developed performance metrics to monitor staff productivity, leading to increased efficiency throughout the department.
- Streamlined credentialing processes by implementing efficient tracking systems and reducing paperwork.
- Ensured accuracy of provider data in internal databases through regular review and updates.
- Developed comprehensive training materials for new hires, promoting consistency in credentialing processes across the organization.
- Managed the onboarding process for new providers, ensuring timely completion of all required documentation.
- Conducted periodic risk assessments to identify potential vulnerabilities in credentialing workflows and implemented corrective measures as needed.
- Led team meetings to discuss progress toward goals, troubleshoot issues, and share best practices among colleagues.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Established team priorities, maintained schedules and monitored performance.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
Accounts Receivable Manager
Grey Ledge Medical Management
06.2021 - Current
- Managed a team of accounts receivable specialists, providing guidance and support for optimal performance.
- Led initiatives to streamline billing procedures, enhancing cash flow management and reducing outstanding receivables.
- Oversaw accounts receivable operations, ensuring timely invoicing and payment collection processes.
- Trained new staff on billing procedures and software applications.
- Implemented financial reporting systems to monitor aging accounts and optimize collection strategies.
- Analyzed account discrepancies, resolving issues promptly to maintain client satisfaction and retention rates.
Accounts Receivable Analyst
Grey Ledge Medical Management
12.2020 - 06.2021
- Processed and managed accounts receivable transactions efficiently.
- Collaborated with cross-functional teams to resolve billing discrepancies.
- Analyzed account performance data to identify growth opportunities and trends.
- Processed and submitted insurance claims with high accuracy and efficiency.
- Analyzed billing discrepancies to ensure timely resolution and compliance.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Developed training materials to support ongoing education for billing team members.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
Business Analyst
Optum360
01.2015 - 12.2020
- Build relationships with existing and potential clients to determine business needs. Provide recommendations to those needs with services provided through our company.
- Support the company initiativesregarding KPIs involving AR over 90, inactives, days in AR, and denials.
- Prepareanalytical financial documentation for monthly client meetings.
- Maintain weekly interaction with the client including a monthly or bi-monthly meeting to review strategic plans based on financial documentation provided.
- Developed a strong network of communication within the company to assist with efficient problem-solving resolutions the company has to offer
Account Manager (Revised Position)
Optum360
01.2007 - 12.2014
- Responsiblefor maintaining client relationships/managing 31 accounts with specialties in Pediatrics, Endocrinology, Gastroenterology, Urgent Care, Plastic Surgery, Pain Management, and Primary Care.
- Support organizational initiatives by overseeing and streamlining billing and collections processes.
- Prepared financial documentation for monthly client meetings.
- Developed educational documentation to assist clients with educational gains in their specialties.
- Provide weekly interaction with the clients to maintainsolid working relationships.
- Developed a strong network of communication within the company to assist with efficient problem-solving resolutions.
- Provide enhanced organizational support by consistently refining subject matter expertise and knowledge.
Assistant Department Manager
Optum360
01.2005 - 12.2007
- Responsible for a 15-member department consisting of Account Managers for 23 specialty groups including Primary Care, hospital-based Departments, and Pediatrics. Assisted Department Manager with departmental responsibilities.
- Analyzed departmental productivity for efficiency.
- Leading the department to convert to a web-based practice management system.
- Hiring of employees
- Preparation of financial documentation for monthly meetings with clients.
- Organized and delegated prioritized work.
- Developed training strategies for new employees.
- Developed effective strategies for managing accounts receivable, charge entry, and payment entry per specialty.
Senior Account Manager
Optum360
01.2004 - 12.2005
- Responsible for managing a multi-milliondollar hospital based practice.
- Launched effective strategies for managing accounts receivable, charge entry, and payment entry in a functional method.
- Attended monthly meetings with clients to collaborate new efficient strategies.
- Responsible for prioritizing daily work to the staff.
- Provided monthly financial data reports during monthly meetings to report financial trends.
Account Manager
Optum360
10.2000 - 01.2004
- Responsible for accurately processing medical claims for a multi-milliondollar surgical practice.
- Ensured accuracy while completing data entry of demographic and medical claim information.
- Developed effective strategies while managing accounts receivable, charge entry, and payment entry per specialty.
- Assisted with training materials and training staff members
- Communicated with the client to provide or obtain corrected or additional information daily
- Provided monthly financial data reports during monthly meetings to report trends
Level II Claims Examiner
Blue Cross & Blue Shield of Rhode Island
01.1999 - 10.2000
- Responsible for verifying medical claim accuracy processed by a 30-member department consisting of Level I Claim Examiners. Medical claims included various Blue Cross &Blue Shield insurance products.
- Developing new strategies to verify medical claims efficiently.
- Provided educational guidance to Level I Claims Examiners to improve accuracy.
- Assisted with release and correction of claims on Error Prevention Reports.
- Chosen to assist with the management and development of a new online claims operating system.
- Managed foreign currency translations for foreign insurance claims.
Level I Claims Examiner
Blue Cross & Blue Shield of Rhode Island
09.1997 - 12.1998
- Responsible for accurately processing medical claims.
- Diligently exceeded data entry time limitations set by the company while entering medical claims.
- Maintained high efficient quality data entry.
Education
High School Diploma - High Honors
LaSalle Academy
Providence, RIPsychology and Management
Rhode Island College
Providence, RI01-2001
Skills
- ICD-10, CPT, & Medical Terminology, Coding, Health Insurance Knowledge, Medical Billing, Understanding Insurance and payer processes, EDI, ERA, EFT Enrollment Processes, Credentialing Enrollment Process, CAQH, Expertise in Powerpoint, Excel, Word, Caretracker, Tableau, ECW, IMS, Intergy, and NextGen Client-Oriented, Strong Interpersonal Skills, Collaboration, Training skills, Conflict Resolution, Effective Communication, Team Oriented, Problem solving abilities
Timeline
Electronic Data Interchange Enrollment Manager
Grey Ledge Medical Management
05.2023 - Current
Credentialing Manager
Grey Ledge Medical Management
06.2021 - Current
Accounts Receivable Manager
Grey Ledge Medical Management
06.2021 - Current
Accounts Receivable Analyst
Grey Ledge Medical Management
12.2020 - 06.2021
Business Analyst
Optum360
01.2015 - 12.2020
Account Manager (Revised Position)
Optum360
01.2007 - 12.2014
Assistant Department Manager
Optum360
01.2005 - 12.2007
Senior Account Manager
Optum360
01.2004 - 12.2005
Account Manager
Optum360
10.2000 - 01.2004
Level II Claims Examiner
Blue Cross & Blue Shield of Rhode Island
01.1999 - 10.2000
Level I Claims Examiner
Blue Cross & Blue Shield of Rhode Island
09.1997 - 12.1998
Psychology and Management
Rhode Island College
High School Diploma - High Honors
LaSalle Academy