Michelle Rebul, BA, CCS, CPC-a, CDEO,                                             Enclosure: Cover Letter Below Resume

Camarillo, CA

Objective   Review, audit, analyze, and code the policies, materials, and processes for optimum marketability and reimbursement continuum for multiple partners within multiple contracts

Accomplishments

·         9/19/2020 – earned Certified Documentation Expert, Outpatient (CDEO), similar to a CPMA, with an additional layer of knowledge of documentation of quality of care & best practices.

·         Wrote reports based on thorough claims analysis and research, resolving provider revenue issues.

·         Over 7 years of successful remote work & travel: coding, billing, guidelines & analysis.

·         Successfully led providers in ICD-10, CPT & TAR knowledge and coding impacts across multiple facility types.

·         Motivated & trained medical provider staff in using electronic resources, EHRS, Telemedicine & Telehealth.

·         Trained coders and physicians EMR best practices/coding and documentation principals through reports.

·         Effectively lead co-workers and related staff in implementing effective changes to Medi-Cal Training Materials.

·         Satisfied L.A. & O.C. Region Medical Providers upwards and beyond 99.9% using best practices.

Special Skills/Experience

·         Audit and apply correct diagnostic and procedural coding

·         Communicate both verbally & in writing, complex revenue issues using charts, graphs, Power points.

·         Train provider billing, Authorizations, Enrollment and Special Programs in large and small group settings including (TAR/eTAR) ICD-10-PCS, DRG, Telehealth Coding/Billing, ICD-9, CPT coding, Electronic Health Records (EHR)

·         Accurately apply revenue guidelines & principals with DHCS policy in a wide range of reimbursement scenarios.

·         Knowledge of CMS.gov, Microsoft, Laserfiche, CAMMIS, WebEx, HTML, Adobe, MHS Genesis and Cerner.

·         Promotes Medi-Cal systems and architectures to the provider community. Comprehensive AHIMA expertise.

Professional Experience

Depart. Of Defense Military Health System                                                                               December 2019 to Aug 2020

EHR Knowledge-Based Trainer

·         Deliver classroom Instructor-Led Training to Providers and support staff for the (EHR) Electronic Health Record including Genesis, PowerPlan, CareCompass, Schapptbook & Cerner Practice Management (CPM) for rev cycle

·         Schedules administrative functions necessary to delivery and coordinate, including travel

·         Lay-off due to COVID-19 cutbacks

Department of Healthcare Services, Medi-Cal Xerox/Conduent

Medi-Cal Sr. Analyst/Provider Trainer, Los Angeles                                                           Dec. 2011 to Dec. 2019

·         Led as a Rep for L.A. successfully training on coding guidelines and principals and researching for providers and facilities, with virtually 100% provider satisfaction for Medi-Cal, Medicare X-Overs & Managed Care Plans.

·         Audited, coded, advised and researched billing, authorization & coding issues & provider records/documentation  and charge errors for optimum reimbursement, including LTC, HHA, Hospice & DRG, IP, OP services.

·         Led provider trainings at regional Medi-Cal Seminars.

·         Researched data using internal data systems for accurate resolution of physician/facility revenue issues.

·         Accurately audited and documented coding for providers and DHCS (Department of Health Care Services).

·         Wrote and developed provider billing and coding and technical training manuals and power point presentations.

·         Facilitated consensus between the provider community and Medi-Cal F.I.s and clinicians within various departments via communication, training and guidance.

·         Escalated provider issues, wrote Problem Statements and made recommendations as appropriate addressing internal issues and fixes.

Coding Auditor

Emergency Groups Office, Arcadia, CA                                                                        Jan 2011 to Dec 2011

·         Audited coder accuracy and physician medical records, improving overall accuracy by 30%, thus reducing the possibility of external audits by 95%.

·         Wrote reports to coders and physicians, advising them of coding & diagnostic rules and guidelines, making recommendations as appropriate.

·         Utilized payer expertise knowledge of OHC, PPOs, MCPs, Medicare, Medicaid for successful EHR review.

·         Audited both electronic and paper medical records prioritizing documentation standards in management meetings.

Michelle Rebul

Camarillo, CA                                                                   cell: 626-234-3933  ~ allwritereb@yahoo.com

Medical Billing/Appeals Dept. Supervisor

So. Calif Neurosurgical Group, Pasadena, CA.                                                                         March 2010 to Jan 2011

·         Supervised the Appeals Dept. involving the articulation of written & oral communications resulting in successfully reducing the age trial and increasing revenue by 75%. Consistently driven and innovative.

·         Supervised appeals personnel for psychiatry services including small meetings and one-on-one coaching

·         Billed neurosurgical and appeals follow-up for neurosurgical physician services.

·         Successfully conducted many audits and clinical review of E&M consultation reports for reluctant payers.

Medical Billing /Coding Instructor                                                                                  Sept. 2009 to March 2010

Meridian Institute, Los Angeles, CA

·         Taught Medical Billing and coding, including included CPT coding and ICD-9-CM practicum/instruction.

·         Gave instruction on the utilization of medical billing software such as PPM & Medi-Soft and taught medical terminology, anatomy and physiology. Semester ending in March 2010.

Professional Experience continued:

ESL/MATH Teacher ~ Irving Middle School, LAUSD                                        July 2004 to June 2005

Multiple Subject Teacher ~ Virgil Middle School, LAUSD                                  July 2001 to June 2004

-Faculty Teacher Mentor

-Leadership in Graduation Ceremonies, Culmination

Teacher ~ Plasencia Math/Science Magnet, LAUSD                                           July 1997 to June 2001

Teacher ~ Loma Vista School, LAUSD                                                             July 1995 to June 1997

-Elected Track C Coordinator

-Elected Grade Level Chair

-Leadership in Preparing and Planning Culmination Activities

-Insurance Sales, American Income                                                                   June 2005-Sept. 2005

-Teacher, Special Education & Substitute, Alhambra School District                    Sept. 2005-June 2007

-Substitute Teacher, Arcadia Unified School District                                           Sept. 2006-March 2010

EDUCATION

California State University – B.A., Communications

Career College Consultants – Medical Billing Coding Certification, May 2009

LAUSD Teacher Credentialing Intern Program

Memberships

AHIMA (American Health Information Management Association) – Certified Coding Specialist Certification (CCS)

AAPC (American Academy of  Professional Coders) – Certified Professional Coder (CPC-A)

Because of COVID-19, I was laid-off due to having the least seniority. However, I have no regrets because of all the knowledge and experience gleaned from one of the most cutting-edge electronic health records systems. Additionally, I have used this time to successfully further my education and earned another certification from AAPC as a Certified Documentation Expert, Outpatient (CDEO). This is similar to a CPMA, with an additional layer of knowledge regarding documentation of quality of care & best practices. As reimbursement models shift from fee for service to quality of care and patient outcomes, the CDEO facilitates efficiently communicating this to payers and federal programs. I was paid $69,000.00 in my last role and want a salary equal with my last salary.

As a DHCS Medi-Cal Sr. Analyst/Regional Rep., I led every day by training providers both remotely and in person, and have given them much assistance regarding CMS guidelines, medical necessity, coding requirements including NCCI edits, DRG, Medi-Cal and managed care plans, Medicare cross-overs and auditing their reimbursement concerns, giving them positive outcomes and great customer service. Much like Emergency Group Office, I assisted coders and physicians with accurate coding and medical justification of services. Provider issues could be as simple as billing too many units for a patient, violating NCCI Edits, not coding specific diagnoses or missing important diagnoses altogether.  This is why great education & customer service was foremost on my mind, which I provided consistently and successfully, every single day.

In my experience working as an auditor, I consistently have analyzed, audited and trained. For example, while working at Emergency Groups Office (EGO), I would review E&M levels, HX, ROS & exam as well as ultrasounds, EKGs, X-rays and MRIs and critical care codes based on medical records among other auditing scenarios. Payer guidelines, such as Medicare, were also part of the focus, along with, of course communicating with physicians and coders about any documentation or coding discrepancies. Another example for Medi-Cal, I recently have worked closely with the City of Hope, on their multiple coding and compliance issues, where I trained a large group of 30 providers. I’ve trained hundreds of providers at seminars & facilities.  Among other duties, I successfully conducted clinical review of E&M consultation services for reluctant payers, receiving all services paid for So. Calif. Neurosurgical Group, among my other duties.