Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

MICHELLE OWUSU

Worcester,MA

Summary

Healthcare Professional with over 15 years of and experience in a healthcare environment. Demonstrates comprehensive knowledge of medical coding and compliance standards, medical care payment systems, and administrative management skills. Oversees coding staff, multiple vendor relationships and workflows for coding, auditing and provider education.

Experienced with patient care, critical thinking, and effective communication. Utilizes medical knowledge to support patient recovery and manage complex conditions. Strong understanding of healthcare protocols and compassionate care delivery.

Overview

28
28
years of professional experience
1
1
Certification

Work History

Registered Nurse

IntelyCare
11.2019 - Current
  • Administered medications and treatments in compliance with healthcare regulations and best practices.
  • Monitored patient conditions, identifying changes and communicating effectively with interdisciplinary teams.
  • Developed individualized care plans tailored to patients' unique needs and preferences.
  • Collaborated with families to provide education and support regarding patient health status and care options.
  • Conducted comprehensive assessments to evaluate physical, emotional, and social needs of residents.
  • Implemented infection control measures to minimize the risk of healthcare-associated infections in the long-term care setting.
  • Provided skilled nursing assessments and interventions for complex medical conditions, enhancing patient outcomes.
  • Maintained accurate electronic health records, contributing to improved quality of care and regulatory compliance.
  • Delegated tasks appropriately to nursing assistants, ensuring efficient delivery of care services while maintaining quality standards.
  • Managed wound care efficiently coordinating with wound specialists when necessary resulting in faster healing rates.
  • Administered intravenous therapy monitoring patient response to treatment and promptly addressing any adverse reactions.

Manager, Risk Adjustment Coding and Education

Fallon Health
08.2011 - Current
  • Led cross-functional teams to enhance project delivery and operational efficiency.
  • Budget management, ensuring alignment with financial targets and resource allocations.
  • Mentored staff, fostering professional development and enhancing team performance.
  • Conducted regular performance evaluations, driving accountability and continuous improvement within teams.
  • Accomplished multiple tasks within established timeframes.
  • Maximized performance by monitoring daily activities and mentoring team members.
  • Reduced errors in medical coding by implementing quality control measures and providing ongoing training to staff members.
  • Ensured accuracy of medical coding by staying up-to-date with current industry standards and attending relevant training courses.
  • Assisted in the design and execution of targeted provider education programs to improve compliance with policies and procedures.
  • Audited and reviewed patient information via EMR management to verify accuracy and completeness.
  • Evaluated medical records for compliance with regulatory standards and best practices.
  • Led audits of medical records, enhancing overall data integrity within the organization.
  • Ensured HIPAA compliance during all stages of the review process, safeguarding sensitive patient information effectively.
  • Identified trends in documentation errors through careful analysis of multiple records, allowing for targeted training initiatives among healthcare professionals.

Chart Review Coordinator/Medicare Data Reimbursement Data Specialist

Fallon Health
08.2011 - Current
  • Responsible for overseeing all issues related to coding process and completion. Manages staff; assigns work accordingly to maximize productivity and instructs in proper coding procedures.
  • Responsible for the creation, maintenance and education of coding assignments, educational aides in compliance with Risk Adjustment regulations and Fallon Health policies.
  • Ensures production and quality expectations are met by staff and 3rd party coding partners.
  • Coordinate with Provider Relations department and coders to ensure smooth access to members medical records.
  • Acts as liaison between Fallon Coding Department to address escalated coding scenarios; updates staff accordingly with CMS and State transmittals, submission of data deadlines.
  • Under the direction of the Risk Adjustment Senior Director, ensures all regulatory, HIPAA, and other compliance directives are met standards with the coding staff.
  • Knowledge of RADV processes and procedures.
  • Provides compliance and coding training for new Fallon Providers during their onboarding processes. Ensures staff is monitoring and educating providers during their initial audit review period.
  • Identifies and reports issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding guidelines.
  • Prepares report status for coding assignments and audit of findings for each audit and the action plan for implementation of recommendations for correction and/or improvement as needed.
  • Knowledge of HCC Risk adjustment model for Medicare and State of Massachusetts.
  • Collaborate with Risk Adjustment Analyst with targeting of members for chart review.
  • Assisted with reduction cost of $15M to net payable of 900k related to the 2015 Massachusetts's risk adjustment settlement.
  • Department liaison of setting up new health plan products with CSSC, MAPD and 3rd party vendor of submission of data to CMS for RAPS and EDPS. Import monthly CMS files MMR, MOR, RxMOR, PDE and more.

Senior Information Coordinator/Reimbursement

Genzyme Genetics
12.2004 - 07.2011
  • Provide accurate and timely billing for provided medical services. Educate medical professionals and their office staff concerning billing, coding, and insurance issues.
  • Retrieve essential information for billing, authorization and pre-cert if needed by contacting appropriate personnel or patients.
  • Ensure proper claim submission, track and follow up unpaid claims.
  • Experienced of regulations of multiple major third party and government payers.
  • Lead on Medicare education to clients and staff which increased revenue.
  • Worked closely with Territory Managers of insurance requirements and regulations.
  • Lead team on obtaining and maintaining over 6,000 physicians credentialing required by insurance carriers.
  • Establish, maintain and update records, databases and files; perform routine analyses in the processing of data for recurring reports.
  • Monitor daily and ensure accuracy of end-of-month, closure.
  • Exceeded daily billing productivity. Required 29 produced over 70 a day.
  • Participated in Quality Assurance Program by identifying opportunities for improving the quality of our services.

Lead Patient Access Coordinator/Administrative Assistant

UMass Memorial Health Care
05.1997 - 12.2004
  • Maintained front office operations in alignment with organization objectives to streamline the flow and enhance service.
  • Operated high-volume phone system and maintained daily direct and indirect client relations operations including acting as point of contact for patients. Collect patients information, and collect co-pays. Handling high volume of scheduling appointments, insurance referrals and verification.
  • Arrange provider work schedules, Master scheduler in IDX. Schedule physician surgeries and postop surgeries.
  • Creating, maintaining and updating of patient charts.
  • Transcription of administrative correspondence, i.e. insurance companies, legal correspondence, letters to referring physicians.
  • Responsible for verification of account deposits and payments of insurance copays and office expenditures.
  • Process timesheets, payroll distribution and sort review, screen distribute incoming and outgoing mail; prepare and compose ensure timely responses to a variety of routine written inquires.

Education

Bachelor of Science - Business

Worcester State University
Worcester, MA

Associate of Science - Office Management/Medical Billing

Quinsigamond Community College
Worcester, MA
05-1997

CPC - CPT, HCPCS, ICD-9

AAPC
Worcester, MA

Associate of Science - Nursing

Quinsigamond Community College
Worcester, MA
05-2019

Skills

  • Staff training and development
  • HCC Coding Medicare and Commercial
  • Work well independently
  • Quality assessment of coded data
  • HIPAA compliance
  • ICD-10 coding experience
  • Proven patience and self-discipline
  • Deadline-driven
  • Medication administration
  • Medication and IV administration
  • Direct patient care
  • Patient assessments
  • Documentation and charting
  • Patient education and counseling
  • Clinical judgment
  • Patient care
  • Wound care

Certification

  • CPC-P - Certified Professional Coder-Payer

Timeline

Registered Nurse

IntelyCare
11.2019 - Current

Manager, Risk Adjustment Coding and Education

Fallon Health
08.2011 - Current

Chart Review Coordinator/Medicare Data Reimbursement Data Specialist

Fallon Health
08.2011 - Current

Senior Information Coordinator/Reimbursement

Genzyme Genetics
12.2004 - 07.2011

Lead Patient Access Coordinator/Administrative Assistant

UMass Memorial Health Care
05.1997 - 12.2004

Bachelor of Science - Business

Worcester State University

Associate of Science - Office Management/Medical Billing

Quinsigamond Community College

CPC - CPT, HCPCS, ICD-9

AAPC

Associate of Science - Nursing

Quinsigamond Community College

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