Michelle Yates
Maplewood,MN
Summary
Reliable Medical Biller with coding and medical terminology knowledge. Polished and hardworking performer with background overseeing accounts and handling work queue and managing those tasks. Team-oriented person with great decision-making skills.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Medical Billing specialist
Regions Hospital
01.2018 - Current
- Process hospital UB and Professional 1500 claim to payer for VA, Out of State Medicaid, Minnesota Medicaid, Ambulance Transportation, Skilled Nursing, Hospice and Worker Compensations Billing
- Assist with calls by patient inquiry internally and externally such as Billing/Registration and payment posting
- Evaluate Account Work Queues in EPIC to resolve Insurance / patient billing discrepancies, Follow-up, Denials, Missing or inconsistent info and Validate patient liability according to the payer remittance or according to the expected payment reimbursement
- Analyze insurance claims for submission to payer; correcting and updating patient Registration/ Demographic and Coverage Information and errors and review prior authorization documents and documenting account notes in EPIC system
- Review Provider Enrollment Spreadsheets to verify physician enrollment.
- Communicated with insurance providers to resolve denied claims and resubmit.
- Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
- Located errors and promptly refiled rejected claims.
- Posted and adjusted payments from insurance companies.
Prior Authorization Specialist
Gillette Children’s Specialty Healthcare (Aerotek Staffing)
01.2016 - 01.2018
- Processed Prior Authorizations, Pre-Determinations, and Notification for Inpatient surgery and Imaging
- Provide Customer Service for Patient and Providers
- Verified Insurance, Pre -Register patient with new or updated insurance changes
- Researched for appropriate CPT (current procedural terminology) coding and ICD-10 diagnosis codes
- Reviewed patient benefits for non-cover services
- Reviewed medical dictations for approvals, appeals and denied claims.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Tracked referral submission during facilitation of prior authorization issuance.
- Verified eligibility and compliance with authorization requirements for service providers.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Analyzed medical records and other documents to determine approval of requests for authorization.
Client Account Specialist
The Emily Program (Accountemps)
01.2015 - 01.2016
- Answered follow up inquiry by phone regarding client self-pay accounts and review applications for financial assistance and direct account to outside collections agencies
- Worked with client management team to develop a financial strategy with clients in regards to client responsibility, deductible, coinsurance and copay resolve delinquent accounts; set up payment plans and follow up on accounts.
- Responded to all client inquiries and asked appropriate questions to facilitate resolution.
Clerical Specialist III
Blue Cross Blue Shield of Minnesota
01.2010 - 01.2015
- Performed in-depth inquires for Prior Authorization for providers to ensure accurate and quality work to meet department goals
- Reviewed and coordinate all medical requests, appeals, complaints, and/or coordinate Worker’s Comp, No Fault Auto and Third Party liability inquires, including but not limited to: processing Medical, Daycare, and Transportation claims/receipts for reimbursement
- Verified Insurance eligibility, Data Entry of insurance information, respond to prior authorization request while keeping current with payor requirements
- Handle calls from internal team members and Assist with onboarding of new employees.
- Completed clerical tasks such as filing, copying, and distributing mail.
- Managed daily data entry and kept clerical information accurate and up-to-date.
- Collaborated with various departments to complete assigned tasks.
- Edited and proofread documents for accuracy and completeness.
- Assisted with onboarding of new employees.
Education
Human Services – A.s. -
Century College
05.2025
Skills
- Microsoft Word
- Some Excel
- Outlook
- 10key
- Cerner Software
- Affinity
- QES (Quadra-Med Scheduling System)
- Varies verifying Insurance systems
- EPIC
- Rightfax
- Onbased
- Image Now
- Insurance Verification
- Claim Submission
- Medical Billing
Activities
- Volunteer, Whitebear Lake Food Shelter, 2017-01-01, 2018-12-31
- Volunteer, St. John’s Hospital, 2010-01-01, 2012-12-31
Certification
- Entrepreneurship St Thomas School of Business Program - Sept 2023 to Oct 2023
Timeline
Medical Billing specialist
Regions Hospital
01.2018 - Current
Prior Authorization Specialist
Gillette Children’s Specialty Healthcare (Aerotek Staffing)
01.2016 - 01.2018
Client Account Specialist
The Emily Program (Accountemps)
01.2015 - 01.2016
Clerical Specialist III
Blue Cross Blue Shield of Minnesota
01.2010 - 01.2015
Human Services – A.s. -
Century College
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