Michelle Vega

• Manage billing and coding for three medical centers, ensuring accurate and timely processing
• Conduct meetings with insurance companies to review and discuss Hedis Reporting, fostering strong relationships
• Post payments from various insurance carriers, maintaining meticulous records
• Educate providers on correct reimbursement procedures, contributing to improved financial outcomes

• Company Overview: Remote position
• Facilitated utilization management intake processes, ensuring efficient coordination of patient care
• Oversee referrals queue, streamlining the referral process and ensuring timely patient care
• Check eligibility for Highmark BCBS, reducing errors and ensuring accurate claim submission
• Enter information into Highmark BCBS system with high precision, minimizing discrepancies
• Successfully maintain a 99% error rate, reflecting meticulous attention to detail
• Played a pivotal role in managing referrals, evaluating medical necessity, and expediting necessary authorizations
• Remote position

• Successfully entered data for 650 Holocaust survivors into Excel, ensuring accuracy and efficient record-keeping
• Managed accounts receivable, handling financial transactions and maintaining financial records
• Processed check requests for emergency grants, aiding survivors in times of need
• Conducted thorough audits of invoices related to homecare services, ensuring compliance with financial standards
• Collaborated with the behavioral health team to support comprehensive services for clients

• Review all medical records received for annual HEDIS audit
• Abstract clinical data from medical records as per the HEDIS measure requirements
• Request any additional information from Providers as needed

• Company Overview: (Contract position)
• Working off monthly reports to bill for multiple medical centers
• Capturing correct codes for proper reimbursement thru Greenway System
• Medicare billing and fee for service billing
• Responsible for all 10 locations for Medicare billing
• (Contract position)

• Company Overview: (Contract position)
• Closing of care gap by delivering reports
• Educating/re-enforcing education on HEDIS and MIPS requirements and quality improvement process
• Reviewing charts claims data and auditing to identify care gaps
• Extracting all supporting notes and report measure specification
• (Contract position)

• Company Overview: (Contract position)
• Code medical records to capture HCC codes
• Perform auditing according to the plan's requirements
• Upload completed quality control over-read reviews to centralized server system via the Internet, associated via web portal
• (Contract position)

• Reviewed records from various providers
• Used QNXT for claims processing
• Abstraction from records which include HEDIS reviews, RISK Adjustment and Medical record reporting
• Reading over records from other auditors to ensure accuracy

• Company Overview: (Contract position)
• Review all patients charts for billing and coding
• HEDIS reviews Risk adjustment and medical record reporting
• Communicate with Providers on coding Evaluation and management
• (Contract position)

• Company Overview: Remote position
• Code medical records according to level of accuracy for Hierarchical conditions
• Coding records into APPX and OSCR programs through Citrix
• Abstract data from medical records from Ortho and PCP records according to 360 exams
• Received via fax/mail or collection in the provider offices and coding the information into the accredited software
• Making sure records pass compliance
• Remote position

• Company Overview: (Contract position)
• Medical Chart data collection/abstraction from medical records received via Fax /mail or collection in the provider offices and coding the information into the accredited HEDIS software
• Coded ICD-9 all types of specialties
• (Contract position)

• Conduct chart review for the purpose of identifying, confirming, and/or documenting appropriate medical coding
• Upload completed quality control over-read reviews to Verisk's centralized server system via the Internet, intranet and associated web portal

• Company Overview: (Contract position)
• Abstraction of medical data from record and assign ICD-9 and procedure codes
• Meeting quality requirements for Hedis and Medicare Risk Adjustment
• Communication with the Physician to clarify diagnosis, procedures and coding documentation
• (Contract position)

• Company Overview: Remote position
• Conduct chart review for the purpose of identifying, confirming, and/or documenting appropriate medical coding
• Perform quality control over-read reviews of previously completed record reviews to ensure accuracy, completeness, and overall high quality of record review processes
• Upload completed quality control over-read reviews to Inovalon's centralized server system via the Internet, intranet and associated web portal
• Remote position

• Qualifies patients for ICP Medicaid/Community Medicaid Hospice patients
• Performs Financial Assessment for charity cases
• Bills and Codes all claims for Medicaid thru Web Portal
• On Call Verification for Nursing Home Placement

• Conduct chart review for the purpose of identifying, confirming, and/or documenting appropriate medical coding
• Perform quality control over-read reviews of previously completed record reviews to ensure accuracy, completeness, and overall high quality of record review processes
• Upload completed quality control over-read reviews to MSR's centralized server system via the Internet, intranet and associated web portal
• Site Review Consultant
• Perform HEDIS chart reviews of care providers, sites, facilities, medical records, and other associated medical-field material, personnel and documents either onsite or at remote locations as designated by the company
• Upload completed reviews to MSR's centralized server system via the Internet, Internet and associated web portal

• Retrieve record documentation of care providers, sites, facilities, medical records, and other associated medical-field material, personnel and documents either onsite or at remote locations as designated by the company at provider according to the health plan requirements
• Upload all scanned charts to Outcomes, Inc
• Via the Internet and associated web portal

• Knowledge of HCPCS billing & coding for medications and Durable Medical Equipment
• Qualify Medicare patients for their Enteral Nutrition, Total Parental Nutrition, & Chemotherapy
• Gather criteria needed to meet the requirements for submissions of Certificates of Medical Necessity
• Adjudication of claims to Medicare & HMO plans for Part D drugs
• Internal Medicare chart auditing
• Handled all monthly billing of Medicare, Preferred Care Partners, Leon Medical Center, Citrus & Doctor Care plans

• HCPCS billing & coding for medications according to their HMO contracts
• Billed & collected on HMO contracts which included AV-Med & United Health Care
• Qualified Medicare patients for Respiratory & Pain Management Therapy
• Lowered the A/R over 90 and brought it current

INFUSAL HOME CARE, INC - Hialeah, FL

June 2003 to July 2004.

• HCPCS coding for billing of infusion therapy and durable medical equipment.
• Billed and collected on HMO contracts, which included AV-Med and United Health Care.
• Managed monthly billing for nursing visits from our home health care providers for RN, LPN, PT, and LCSW on all HMO contracts.
• Monthly reporting on all A/R accounts for review, resubmission, or write-off.
• Qualified all Medicare patients for enteral nutrition, total parenteral nutrition, and pain management therapy.
• Accurate tracking on all CMNs for Medicare patients.