Niagara Falls Medical Record

Michelle Krolewski

**** ***** ******, ******* *****, New York 14303-2035

716-***-**** ********@**********.***

Qualifications Profile

Experience in the health care field with proven strengths in insurance orientation and compliance.

UM Case review to determine appropriate criteria for Skilled Care, DME, Denial/NOMNC Letters per Medicare Guidelines.

Review of insurance contracts and provider memos regarding Referrals, Co-pay, Deductible, Medical Necessity and Length of Stay requirements. Staff education and implementation of changes

Outstanding interpersonal and communication skills; superior accuracy in patient history, charting, Quality Management and Chart Audits.

Administrative and referral experience including admissions, assessment, treatment, referral, and education for a wide range of patients/staff.

Versed in clinical criteria in an office and hospital environment.

Responsible for administering and maintaining the ED Electronic Medical Record.

Supervised the implementation of Charge by Documentation for the ED Electronic Medical Record.

Implemented front end Revenue Cycle “Best Practices”.

Prepared yearly budgets as Department Director.

Selection Team member that previewed the hospital wide Electronic Medical Record, ED and Centralized Scheduling Systems.

Yearly staff evaluations, counseling, maintenance of department staff folders, applicant screening,

Interviewing and hiring, employee orientation and safety training.

Research and trial preparation for Medical Malpractice Cases. Hospital policy review to establish criteria for negligence and deviation from standard of care.

Certifications and Proficiencies

Certifications: Licensed Practical Nursing, SUNY School of Management, Basics of CPT

Coding, FEMA, Infection Control Principles, Computer Basics and Typing.

Proficiencies: Age Specific, Safety/ Staff Counseling, Disaster Preparedness, Safety Committee.

Training/Development: NFMMC Annual Management/Leadership Retreat, SMS Conference, IBEX User’s Group Conference, HFMA (Healthcare Financial Management Association), HIPAA Committee NFMMC, Revenue Cycle Task Force

Organizations: Board Member NFMMC Credit Union (2004-2007), Past Member NFMMC Auxiliary, Active in local Political Committees/Rebuilding NF, Neighborhood Block Club, Church Volunteer.

Computer Skills

Ibex

Kronos

Infoclique

SMS

IHA

Optum

Medent

UHC

Microsoft Excel

Univera

Microsoft Outlook

Healthenet

PROFESSIONAL EXPERIENCE

Buffalo Niagara Physical Therapy 1/2020 – 5/2024

180 Park Club Lane, Ste 225A

Williamsville, NY 14221

*Front Office Manager/Insurance Verification/Authorizations

Review schedules, verify Insurance for authorizations, copays. Obtain Authorizations. Verify patient insurance coverage and update records accordingly. Communicate with insurance companies to obtain benefit information Assist patients with insurance-related inquiries and explain coverage details Ensure that claims are processed correctly and timely Handle denials and appeals and communicate with healthcare providers as needed. Fill in for office staff as needed.

Family Choice of New York 6/2014 – 11/2018

3332 Walden Ave, Depew, NY 14043

*Utilization Management Nurse

Review Records to provide authorization for Skilled Care, DME and Transportation for members in

Skilled Care facilities per Medicare Guidelines. Follow Clinical Cases for transitions from Hospitalization

until readmit to Skilled Facility. Track Inpatient Hospitalizations, ER Stays, Observation, and Skilled

Care Part A Days.

Independent Contract Assignments 3/2012 – 5/2014

*Legal Case Review

Record Review/Medical Summary Preparation

Independent Health 4/2011 – 2/2012

511 Farber Lakes, Buffalo NY 14221

*Health Coach

Telephonic engagement to assist members in managing health issues and achieving personal wellness goals. Identify barriers and assist members in making long term lifestyle changes.

Paul William Beltz PC Law Firm 1/2009 – 4/2011

36 Church St, Buffalo NY 14202

*Legal Nurse Consultant –Intake Nurse for potential Medical Malpractice cases. Research potential of cases to file suit, contact experts for case review and compile Medical Summary/Record Packet for Expert Evaluation. Compile Medical Notebooks and assist with Trial preparation. Meet with potential clients and oversee case logs.

Niagara Falls Memorial Medical Center 2/1995 - 8/2007

621 Tenth St., NFNY 14302 / 6934 Williams Rd., NFNY 14304

*Ibex Coordinator – (Temporary Position) - (6/06-8/07) - Maintained the Ibex EMR System. Interfaced with physicians, administration and employees utilizing the system. Provided guidance to project teams and programmers on how to develop, purchase, test and implement the information system. Assisted all users in establishing credentialing and educated users on system applications. Audited charts for billing compliance & benchmark initiatives. Tested all new upgrades and assisted with implementation.

*Director of Patient Access Services/ ED Registration - (11/01-6/06) – Responsible for the day-to-day operation of the department including oversight of Outpatient, ED & Summit Registration, Centralized & Surgery Scheduling, Insurance Verification and Pre-Op Registration which included Medical Necessity Checking for Medicare Eligibility. Developed departmental policies and procedures, prepared yearly budgets for (3) Cost Centers and was responsible for staff evaluations, counseling, interviewing and hiring for open positions within the department. Served in the role of back-up for schedule preparation and payroll processing when Supervisor took PTO. Managed 45+ employees.

*Medical Necessity Supervisor – (8/01- 11/01) – checked Medicare Medical Necessity prior to Outpatient Services testing. Developed policy to obtain signage for payment and notification of services to comply with Federal Regulation Billing Practices. Prepared staffing schedules and payroll for Outpatient, Registration and Emergency Room Registration staff.

*Clinical Coordinator NFMA – (4/99-8/01) – Coordinated all clinical operations of Summit I Office including scheduling and staff evaluations, record keeping, government regulation for an office setting in addition to staff nursing responsibilities. Regular chart audit to ensure protocol compliance.

*Staff Nurse – (2/95-4/99) - Accurately obtained and documented patient history and medication lists, assessed individual conditions and needs, obtained insurance referrals for outpatient testing, vaccination administration, EKG, Pulse-ox, spirometry and phlebotomy testing. Prepared equipment and assisted physicians during patient examinations and treatments. Maintained a high degree of accuracy for chart documentation of patient medical and health records. Provided triage, referral and health teaching for the Group Practice.

Dr. Ronald Schwartz DDS / Dr. David Gleason DDS 7/1987 – 2/1995

604/606 Forth St., NFNY 14301

*Practice Administrator - Managed all aspects of the Dental Office. Maintained a record of business transactions, billing, filling, insurance pre-authorizations, Pre-procedure treatment plan and referral letters. Chair-side assisting as needed.

EDUCATIONAL BACKGROUND / LICENSURE

Trott Vocational High School

Course completion Marketing/Math/Statistics/Biology – NCCC / Niagara University

Licensed Practical Nurse (LPN), State of New York

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