Michelle spent the first 15 years of her career in the medical billing industry working for insurance companies, such as Blue Cross and Blue Shield. She then went on to work the next 15 years for a medical billing company as a billing manager.
It was during her tenure as a medical billing manager, coupled with her previous experience at medical insurance companies, that she began to see all the areas where the typical medical biller, and billing companies, were falling short. Furthermore, she found that she was able to leverage her experience at BCBS to not only aid her in having a high denial reversal rate, but also in her appeals when an insurance company paid at a rate that was below reasonable and customary.
In both capacities I noticed that the majority of claims being processed were just that – being processed. No one took the time to visually examine the claim before submission, and rejections, denials, and underpayments were often the result. Because of my experience and expertise, I know when procedures are missing from the op notes, or codes/modifiers are incorrect or missing. It takes only a little more time, but visual inspection is worth the time spent because the physicians will get paid more fully for the work that they have already done.
Some of Michelle’s most prized accomplishments include:
#1-Ranked Children’s Hospital
Within 18 months of taking over the billing for this prestigious concern, Michelle had recovered of $640,000.00 in lost revenue. She continued to recover an average of $65,000.00 per month in missed billing opportunities.
Specialty Surgical Center
On one particular case, a major insurance firm paid only 10% of a six figure claim. Michelle appealed for more compensation, and the Center was rewarded with an additional 60% of the total claim amount filed.