Medical Manager

Michelle J Young

Cell# 903-***-**** **********@*****.***

An office manager with over 17 years experience in Medical Office Operations within fast-paced environments, ability to lead and motivate employees. Familiar with all aspects of daily business operations including; Personnel, HR issues, HIPPA and OSHA compliance, Contract Negotiations and numerous administrative functions.

CORE PROFESSIONAL STRENTHS:

TEAM BUILDING EMPLOYEE MOTIVATION ACCOUNTS PAYABLE/RECEIVABLE

POLICIES AND PROCEDURES CODING: CPT ICD10 DISABILITY CLAIMS

PROBLEM SOLVING STAFF TRAINING CUSTOMER SERVICE

WORKERS COMENSATION MEDICAL KNOWLEDGE AND TERMINOLOGY

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PROFESSIONAL EXPERIENCE:

Texas Partners in Pain Management, Woodlands, TX Jan2017-Present

Clinic Manager

Manage clinic and Anesthesia staff on day-to-day operations.

Coordinate clinic operations and activities to ensure proficiency and quality service is delivered within all sections of the clinic; ensuring compliance with regulations and standards.

Responsible for employee performance management by completing performance appraisals and setting individual goals as outlined in policies and procedures.

Effectively lead and develop a team of employees including hiring, training and development, salary recommendation, etc.

Prepare, recommend, and monitor clinic budget, goals, and objectives taking into consideration input from clinic staff. Participate in the planning and development of long range plans

Ensure and maintain environment to comply with regulations, licensure and accreditation requirements.

Serve as the first point of contact for patient and external customer complaints. Reconcile and investigate all complaints relating to practice operations.

Anesthesia division- reviewed and scanned all Anesthesia records for both office and surgery center for billing purposes.

Maintain all credentialing documentation for office providers and Anesthesia team.

The list is long as my duties vary daily.

Provider Business Partners, Howe, TX January 2016-January 2017

Insurance Verification Specialist/Referral for Pain Management-Lead

Verified insurance policies, obtained authorization for procedures, discussed with patient are their financial responsibility prior to their appointment.

Maintain accurate records of external referral patient’s appointments that are kept, failed and current status.

Fax referral form to providers that do not require any records to be sent.

Supervised a team of 6

Maintained updated insurance policies from each Network to secure accurate information for billing purposes.

St. John Medical Center, Tulsa, OK May 2013 – February 2015

Referral Specialist III-Lead

Receives and documents, telephonic, and electronic requests for referrals from Primary Care Physicians, Specialists and Ancillary providers.

Contacts review organizations and insurance companies to obtain prior approval requirements and submit appropriate documentation.

Verifies member eligibility and basic benefit coverage levels including obtaining information on coordination of benefits and third party liability as appropriate.

Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers)

Per referral guidelines evaluates each referral request to ensure the referral request including codes, place of service, service type, provider and all required medical information is available for submission to insurance carriers.

Investigates and obtains from providers, missing medical information required for referral submission.

Applies knowledge and application of ICD-9 and CPT coding, as well as medical terminology for appropriate communication with physicians and providers

University of Oklahoma-Pediatrics, Tulsa Sept 2012 – May 2013

Patient Care Coordinator III

Schedule appointments for 14 providers

Verified Insurance

Scan Patient records

Oklahoma Dept of Rehabilitation Services, Oklahoma City, OK Jan 2009 – Sept 2012

Rehabilitation Technician II

Arrange and Coordinate client services and disseminate required information to vendors, clients and staff. Assists clients in completion of application

Provides clients with area resource referral information

General office operations

Order all office supplies/furniture

EDUCATION:

Green Country Technology Center, Okmulgee, Oklahoma March 2013

Medical Terminology/Coding

Currently working on my billing/Coding certificate

PROGRAMS AND CERTIFICATIONS:

•CPR, First Aid, and BLS certified, valid until 2019

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