Michelle Werner
Health Care Admin
Groves,TX
Summary
Results-driven Provider Healthcare Specialist with extensive experience at United Health Care Optum, recognized for expertise in healthcare coordination and claims evaluation. Demonstrated success in streamlining reimbursement processes and fostering strong provider relationships, leading to increased satisfaction rates.Skilled at addressing complex billing issues, contributing to enhanced operational efficiency.
Overview
20
20
years of professional experience
Work History
Provider Reimbursement Specialist
United Health Care Optum
Groves, TX
03.2020 - 02.2025
- Assisted in developing new processes for more efficient management of reimbursement requests.
- Created detailed spreadsheets documenting all claim information made by the organization.
- Investigated complex cases involving multiple providers or incorrect coding and billing issues.
- Verified clients' insurance claims coverage by coordinating with providers.
- Monitored claim details for non-payments, delayed payments, and other irregularities.
- Answered customer questions to maintain high satisfaction levels.
- Reviewed engine assigned codes and modifiers to update and verify accuracy.
- Participated in annual reviews of existing SOP's related to business process's.
Provider Relations Advocate
United Healthcare Optum
Groves, TX
05.2015 - 02.2025
- Participated in facility aging's to ensure quality relationship with customers.
- Attended conferences and seminars focused on healthcare industry trends that may affect provider relations activities.
- Received patient inquiries or complaints and directed to appropriate medical staff members.
- Facilitated meetings between united personnel and external providers such as Nursing Facilities.
- Collaborated with Nursing facilities and administrative staff to meet patient needs.
- Instructed providers on procedures and policy limitations for and plans.
- Maintained accurate records of all communications with providers including emails, letters, phone calls.
- Assisted providers in understanding their contractual obligations and ensured timely resolution of any discrepancies or disputes.
- Customized onboarding plans to meet the specific needs of different facilities and members.
- Scheduled or conducted new facility orientations for new products.
Business Office Specialist
Gulf HealthCare South West LTC
Port Arthur, tx
01.2010 - 04.2015
- Maintained computers, telephone systems, copiers and fax machines.
- Executed billing tasks and recorded information in company databases.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Checked insurance eligibility by making appropriate phone calls and conducting research on services rendered.
- Determined proper codes for medical records and patient services.
- Followed up with appropriate parties to obtain prompt payments.
- Worked with multiple departments to check proper billing information.
Unit Administrative Assistant
Medical Center Of Southeast Texas
Port Arthur, TX
01.2005 - 01.2010
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Adhered to strict HIPAA guidelines to protect patient privacy.
Education
Some College (No Degree) - General Studies
Lamar University
Beaumont, TXSkills
- Healthcare Coordination
- Creating Standard Operating Procedures
- Claims Evaluation
- Billing specialist
- Insurance Eligibility Verification
- Analytical Problem Resolution
- Provider Relationship Development
- Informative Presentation Skills
- Workforce Development and Engagement
- Facilitating Provider Onboarding
- Interpersonal Conflict Navigation
- Field Evaluations
- Quality Assessment
- ICD 9 coding
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Provider Reimbursement Specialist
United Health Care Optum
03.2020 - 02.2025
Provider Relations Advocate
United Healthcare Optum
05.2015 - 02.2025
Business Office Specialist
Gulf HealthCare South West LTC
01.2010 - 04.2015
Unit Administrative Assistant
Medical Center Of Southeast Texas
01.2005 - 01.2010
Some College (No Degree) - General Studies
Lamar University
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