Michelle Walls
Danville
Summary
Results-driven claims analyst with extensive experience in provider relations and claims management. Demonstrated ability to analyze complex claims data, enhance client satisfaction, and improve operational efficiency. Proven track record in facilitating provider onboarding and resolving claims issues while maintaining compliance with CMS and Medicaid regulations.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Provider Relations Specialist
Gainwell Technologies
Indianapolis
10.2024 - Current
- Facilitated provider onboarding and training sessions to enhance engagement.
- Managed provider inquiries and resolved issues, enhancing provider satisfaction.
- Cultivated strong relationships with healthcare providers, fostering collaboration.
- Coordinated communication between providers and internal teams for smooth operations.
- Resolved conflicts between providers and payers through effective communication strategies.
- Analyzed provider feedback to pinpoint improvement areas in services.
- Developed educational materials for providers on policy changes and procedures.
- Prepared detailed reports on provider performance metrics for management review.
Account Executive- Managed Care
Indiana University Health
Indianapolis
08.2021 - Current
- Lead contract negotiations for hospital reimbursement
- Negotiated contract language and reimbursement terms with out-of-network payers for single-case agreements to enhance provider support
- Managed assigned contracted payer accounts to ensure compliance and optimize reimbursement processes
- Manage provider-escalated claims reports and contracting issues
- Liaison between the hospital billing team and assigned contracted payers
- Collaborate with payer claims representative to resolve provider claims
- Facilitated meetings with payers and coordinated internal research on claims issues to streamline resolution
- Mediate issues and concerns escalated to me by the hospital accounts receivable team and contracted payers
- Provided ongoing support and service to IU Health providers and contracted payers to ensure their needs were met
Provider Relations Representative/Claims Lead
MDwise
Indianapolis
12.2016 - 08.2021
- Developed and nurtured positive relationships with contracted providers to enhance collaboration and support.
- Collaborated with providers on quality metrics and value-based care
- Identified and led strategies to help providers reach metric goals and identify missed opportunities
- Monitored provider or facility patient encounter data to assist in HEDIS goals and identify missed opportunities
- Reviewed and ensured compliance with Medicaid guidelines for enrollment, credentialing, and contracting processes.
- Led claims projects and analyzed claims data to report to the internal configuration team and provider offices
- Analyzed provider claims reports to identify trends in billing issues, reimbursement, compliance with CMS and IHCP guidelines, and system configuration errors.
- Conducted outreach to new physicians and ancillary providers, ensuring network adequacy and expanding service access.
- Facilitated communication between healthcare providers and insurance companies to resolve issues.
- Resolved complex provider inquiries and escalated issues to appropriate departments for timely resolution
- Represented MDwise at Quarterly Association meetings with state home health and hospice (IAHHC), LTACHS (IHCA), DME (Great Lakes Association), and primary care providers (IPHCA). This included- preparing and responding to agenda items to provide status updates to FSSA, OMPP, and Gainwell.
Practice Manager
Oral Surgery & Dental Implant Center (West 10th Dental Group)
Indianapolis
09.2010 - 12.2016
- Led and supported team of office staff, providing guidance and training to optimize performance and deliver excellent patient care
- Implemented and maintained office policies and procedures, ensuring regulatory compliance and fostering a safe, efficient work environment
- Oversaw daily operations of oral surgery office, managing scheduling, patient communication, and resolving issues to enhance patient experience
Education
MBA - Business Administration and Management
Indiana Wesleyan University
Indianapolis, IN08-2003
Bachelor of Science - Healthcare Administration
Indiana University Bloomington
Bloomington, IN05-1997
Skills
- Provider Relations
- Claims Management
- Claims Analysis
- Billing
- Claims process optimization
- Provider contract management
- Electronic Health Records/EMR
- CMS and Medicaid regulations
- Managed Care
- HIPAA compliance
- Policy compliance
- Provider education
- Complaint resolution
- Relationship building and retention
- MS Office
- Claims management
- Medical Coding
References
- Chasity Howell, VP Provider Relations/ MDwise, chowell@mdwise.org
- Amanda Wilson, Healthplan Claims Manager/UnitedHealthcare, amanda.wilson09@yahoo.com
Certification
- Project Management Essentials
Timeline
Provider Relations Specialist
Gainwell Technologies
10.2024 - Current
Account Executive- Managed Care
Indiana University Health
08.2021 - Current
Provider Relations Representative/Claims Lead
MDwise
12.2016 - 08.2021
Practice Manager
Oral Surgery & Dental Implant Center (West 10th Dental Group)
09.2010 - 12.2016
MBA - Business Administration and Management
Indiana Wesleyan University
Bachelor of Science - Healthcare Administration
Indiana University Bloomington