MICHELLE PHILLIPS
Newtown,OH
Summary
Ambitious professional bringing a robust background in the medical coding and quality auditing field. Currently held certifications from the AAPC include the Certified Professional Coder, Certified Professional Medical Coding Auditor, and Certified Professional Practice Manager. With over twenty years of healthcare experience and eight of those years in medical coding and revenue cycle management, I have a proven track record of success across a wide range of industries. I possess exceptional interpersonal, problem-solving and analytical skills to provide advice and expertise to client organizations improving business performance. Experienced in all aspects of medical coding and auditing, leadership, educator, and marketing strategies.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Coding Quality Analyst
Optum Insight
06.2022 - Current
- Current role within the Fraud, Waste, Abuse, and Error department.
- Responsible for the investigation, review, and to provide clinical and coding expertise on pre-pay claims for Medicare and Community and State cases.
- Analyze medical records for accuracy and adherence to correct coding guidelines, review historical claims for duplicate claims and global periods, determine the validity of the claim, and provide any findings in written communication to the provider.
- Research accuracy of billed charges using state and federal regulation guidelines, reimbursement policies, and contract compliance.
- Identifies any aberrant billing patterns, evidence of fraud, waste, or abuse. Recommend providers based on evidence to be flagged for review.
- Optum Insight EHR/revenue cycle software system and Encoder Pro used.
- Maintains an above standard level of accuracy in my quality of decision rulings on cases. Case specialties may include for example escalations, high revenue cases, Anesthesia, Obstetrics, Inpatient, Outpatient, Emergency Department, Orthopedic, and Pediatric procedures and Evaluation and Management CPT assignment. Surgery cases may include spinal, orthopedic, podiatry, or oncology, etc. Injection and Infusions CPT assignment includes both chemotherapy and non-chemotherapy drugs. Dermatology procedures, ophthalmology, Durable Medical Equipment, TPN, nerve blocks, laboratory and genetic testing, and radiology specialists are other examples.
Coding Revenue Cycle Liaison
TruBridge, LLC
02.2020 - 05.2022
- Collaborated with the internal compliance and auditing department after identifying coding errors and NCCI Medically Unlikely Edits to address areas needing correction and education for staff.
- Queried providers and healthcare clients for clarification and/or resolution of incomplete documentation.
- Worked within Rycan denial management and reporting solutions software, Evident's Thrive EHR, Cerner EHR, and TruCode Encoder.
- Previous TruBridge role as a Medical Coding Specialist. Responsible for multiple Emergency Department clients. ProFee coding, facility coding, injection and infusion CPT assignment, Critical Care and Trauma activation coding, and CPT procedural code assignment performed based on individual client needs.
- Client contact for an ED group assignment. Received updates on changes in the client's procedures. I then educated management and staff on discussed changes.
- Responsible for the training of new staff for the same client. Training included Cerner EHR system training, job shadowing, policy education, all initial compliance auditing of completed cases, and any follow-up guidance needed to become compliant with at least 95% accuracy.
Revenue Cycle Specialist
Amy Brenner MD & Associates
04.2019 - 02.2020
- Utilized Allscripts EHR and Payerpath, Optum Clearinghouse and Pay.
- CPT assignment and ICD-10-CM diagnosis assignment for all gynecology and other women's health in-house office visits, radiology, and procedures.
- CPT assignment and ICD-10 diagnosis assignment for all inpatient and outpatient surgeries performed by providers.
- Cleared any NCCI edits received, corrected denials, and wrote appeals as needed.
- Processed all explanation of benefits, e-payments, and posted all payments by cash and checks. Prepared daily bank deposit.
- Insurance validation, copayment and coinsurance verification, insurance claim follow-ups, and pre-certification of tests and procedures.
- Ran aging reports and contacted patients with outstanding invoices or processed refund balances as needed.
- Set up payment plans for patients with financial aid needs.
- Reported patients to collections for overdue invoices per policy. Removed patients from collections after accounts paid in full or bankruptcies.
- New provider credentialing and renewals. Provider license renewals.
- Performed on-site provider coding audits to determine accuracy and compliance with coding guidelines. Followed up with any provider education training required.
- Identified opportunities for process improvement, leading to a more efficient workflow within the office revenue cycle.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Maintained up-to-date knowledge of all coding updates and industry regulations, ensuring compliance with all relevant guidelines and legislation. Educated providers on all changes utilizing presentations, the monthly employee newsletter, or by email.
- Processed and tracked requests for medical records from external organizations.
- Followed up with medical staff regarding missing information in patient records.
- Assisted in training providers on correct coding procedures.
- Served as the revenue cycle resource for the clinical team and administrative staff by offering expert advice on proper code selection based on diagnosis or treatments, and any front end revenue cycle questions.
- Handled all in person questions, emails, and phone inquiries from patients.
Emergency Room Coding Audit Contract
Medical Reimbursement Inc.
11.2019 - 12.2019
- Medical Coding Quality Auditing contract for previously managed Emergency Department/Observations group.
- Reviewed 750 charts for accuracy of ProFee and Facility E/M levels, CPT procedural code assignment, injection and infusions, and ICD-10 diagnosis code assignment. Audit included charts completed by in-house coders, remote coders, and 3rd party vendors.
- Created reports for company executives and hospital client team that identified coding errors and education opportunities to improve quality ratings.
- Cerner software systems
- Contract completed as of December 31, 2019.
Certified Professional Coder/Team Lead/Auditor
Medical Reimbursement Inc.
02.2016 - 04.2019
- Emergency Department ProFee and Facility E/M leveling and CPT procedural code assignment.
- Observation admittance Facility E/M leveling and CPT procedural code assignment.
- Cerner, Epic, Citrix, and IDX EHR software systems used.
- Trauma I activation.
- Academic hospital system.
- Infusion and injection coding.
- Critical Care services.
- Radiology coding.
- ProFee E/M assignment for inpatient cases; Infectious Disease, Intensive Care Unit.
- Promoted to Team Lead, January 2018.
- Promoted to Interim Manager (group manager on medical leave) November 2018.
- New coder training on proper use of Cerner EHR system, group rules and expectations. Oversaw ramp production process and mentored employees until achieving production goals. Performed quality auditing for all new employees until a 95% quality score was maintained.
- Daily and monthly reports created for executives and clients.
- Daily work distribution to in-house, remote coders, and 3rd party vendors.
- Daily NCCI edits and missing charges reports and reconciliation.
- Contributed production metrics and goals in client meetings and any client communication.
- Worked with the Chief Finance officer to improve coding practices within group.
- Oversaw any needs and concerns of billing department and administrators assigned to group.
- Held staff meetings as needed to provide training for coding and policy updates and any focus areas identified by employees to ensure coding quality and production goals were met. Worked with the team to find solutions to any pre-existing issues hindering goal achievements.
Education
Bachelor of Arts - Forensic Psychology
Southern New Hampshire University
Hooksett, NH04.2025
AI in Medical Coding Course.
AAPC
Salt Lake City, UT04.2024
Certified Professional Practice Management Course.
AAPC
Salt Lake City, UT12.2021
Certified Professional Medical Auditor Course.
AAPC
Salt Lake City, UT12.2020
Certified Professional Coding Course
AAPC
Salt Lake City, UT02.2016
Diversified Health Occupations
Great Oaks Career Campuses
Cincinnati, OHHigh School Diploma -
Batavia High School
Batavia, OHSkills
- Coding review of medical records/supporting documentation against submitted claims to determine coding and billing accuracy
- Trained for an Expert Level of understanding of all coding principles for Professional/Facility coding claims using the Healthcare Common Procedure Coding System level I, Current Procedural Terminology (CPT) codes, and HCPCS level II codes (examples include E/M, Anesthesia, Cardiac Interventions, DME, Therapy, Surgical Procedures, Wound Care, Radiology, Laboratory/Pathology, Compounded Drugs, etc)
- Research for submitted claims, medical records, and supporting documentation for correct coding using regulatory requirements and guidance resources such as CMS, CPT/AMA, and major payer policies
- Clear documentation of any findings within case records
- Expert level of understanding for Medicare/Medicaid/Commercial coding and billing policies and procedures
- Pro-fee Inpatient/Outpatient Evaluation and Management code assignment/auditing
- Emergency Department/Observation Facility level assignment/auditing
- ACEP Facility Coding Model
- Infusion and Injection code assignment/auditing
- Professional and Outpatient Facility drug claim review
- CMS National Drug Code billing guidelines
- Trauma Center Levels I-V/Academic hospital auditing/coding experience
- ICD-10-CM Assignment/Auditing
- Accounts Receivable/Electronic Payments/EOB/COB
- Insurance denials/Precertification/Insurance follow-up, Insurance verification
- Clearinghouse
- Charge Capture
- Extensive knowledge of multiple EHR Systems (Cerner EHR software system, Optum Claims Data platform, Allscripts, IDX, Evident/Thrive, EPIC, Citrix)
- Optum Encoder Pro/TruCode Encoder proficiency
- Rycan Revenue Cycle Management System
- Production distribution (In-house coders, remote, and 3rd party vendors)
- Site specific daily and monthly closing/reports
- Edits (NCCI, MUE, etc), missing charges, incomplete's, aging claims
- Budgets, Project management, Physician Documentation Education
- Resourceful and reliable worker, who is an adept multi-tasker and a highly organized solution seeker, that strives for teachable moments for self and others
- Marketing expertise
- Parliamentary procedure understanding
- Effective Communicator and Public Speaker
- Program Oversight
- Community Outreach
- Employee Coaching
- Leadership and People Development
- Annual Planning
- Membership Growth
- Employee Motivation and Performance
- Lectures and Discussions
- Training Method Development
- Strategic Planning
- Team Leadership
- Client Relationship Management
- Social Media Best Practices
- Vendor Relationship Management
- Research methods
- Events logistics management
- Team mentorship
- Committee Organization
- Media Relations
- Decision-Making
- Records Management
- Utilizes "The Success Principles" for goal setting and accomplishment
Accomplishments
President ,
AAPC Cincinnati Local Chapter, 2021
Education And Leadership
2021, 2020, 2016, December, 2021, December, 2020, July, 2016
Affiliations
- AAPC chapter member since 2016.
Certification
- CPC-Certified Professional Coder
- CPMA-Certified Professional Medical Auditor
- CPPM-Certified Professional Practice Manager
Timeline
Coding Quality Analyst
Optum Insight
06.2022 - Current
Coding Revenue Cycle Liaison
TruBridge, LLC
02.2020 - 05.2022
Emergency Room Coding Audit Contract
Medical Reimbursement Inc.
11.2019 - 12.2019
Revenue Cycle Specialist
Amy Brenner MD & Associates
04.2019 - 02.2020
Certified Professional Coder/Team Lead/Auditor
Medical Reimbursement Inc.
02.2016 - 04.2019
Bachelor of Arts - Forensic Psychology
Southern New Hampshire University
AI in Medical Coding Course.
AAPC
Certified Professional Practice Management Course.
AAPC
Certified Professional Medical Auditor Course.
AAPC
Certified Professional Coding Course
AAPC
Diversified Health Occupations
Great Oaks Career Campuses
High School Diploma -
Batavia High School
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