MISHA MCGLORY
Chicago,IL
Summary
Dedicated and results-oriented healthcare professional with nearly 10+ years of diverse experience. Proven track record of success in revenue cycle management, medical billing, and insurance operations. Achieved double promotions over the course of five years at UIC College of Dentistry, reflecting a commitment to excellence and consistent contributions to the organization's financial growth. Expertise in insurance reconciliation, accounts receivable analysis, and claim processing, underscored by a strong command of EHR systems and compliance standards. Adept at leading cross-functional teams, improving processes, and delivering impactful presentations. Dynamic problem solver and dedicated collaborator, poised to drive operational efficiency and deliver exceptional financial outcomes. Demonstrated ability to interpret and apply ICD-10 and CPT codes to streamline approvals and ensure accurate billing, including high-level services like allogeneic/autologous transplants at UI Health. Also experienced in collaborating with insurance providers, managing transplant referrals, and facilitating cross-departmental communication to support timely and efficient patient care.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Healthcare Reimbursement Analyst II/BMT Financial
UI Health
07.2024 - Current
- Verify patient insurance coverage using Availity to ensure eligibility for transplant procedures.
- Coordinate with insurance providers to secure approvals for transplant-related services.
- Contact insurance providers to obtain outpatient evaluation and transplant procedure approvals using appropriate ICD-10 and CPT codes, including 99205 for evaluations and 38240/38241 for transplant services
- Registered transplant donors in the Epic system, ensuring accurate and complete patient records; created and bundled transplant episodes for streamlined care and billing
- Request and monitor transplant prior authorizations to ensure timely approvals and minimize delays in care.
- Enter and submit charges for allogeneic transplant patients using the Unit Charge Entry module in Epic to ensure accurate billing and revenue capture
- Upload approved transplant referrals into Media Manager and accurately enter referral details—including codes and expiration dates—into the Referral Entry module in Epic
- Verified transplant benefits for patients with commercial insurance plans—including BCBS, Aetna, Cigna, and HMO/PPO policies—accepted at UI Health to ensure coverage eligibility and streamline approval processes
- Sent Transplant Memos via email to relevant departments upon completion of transplant procedures to ensure timely communication and care coordination
Healthcare Reimbursement Analyst I
UIC College of Dentistry
03.2022 - 07.2024
- Continued Medical Insurance Associate Duties
- Designed and delivered informative presentations for Fiscal Clerk training sessions
- Presented monthly topics to the fiscal clerks and clinic managers, such as insurance overview (Medicaid and Commercial)
- Served as a liaison for UIC's online payment portal, 835i, and collection project
- Managed seamless entry of all online payments into the Axium system
- Monitored and reconciled EDI clearinghouse claims for accuracy
Medical Insurance Associate
UIC College of Dentistry
06.2019 - 03.2022
- Collaborated with diverse dental insurance providers to ensure timely resolution of outstanding accounts receivable, addressing errors and optimizing payment processes
- Spearheaded data analysis initiatives to identify payment trends among various dental insurance companies, contributing to strategic revenue collection strategies
- Managed Medicaid coverage updates for CDT changes, ensuring compliance with evolving regulations and facilitating accurate billing
- Orchestrated efficient insurance portal access for fiscal clerks, streamlining information flow and enhancing team productivity
- Facilitated accurate patient refunds through TEM, investigating discrepancies and ensuring adherence to refund timelines
- Produced comprehensive monthly reports for claim reimbursement, offering insights to enhance revenue optimization efforts
- Worked closely with third-party insurance payers, including HMOs, PPOs, and Medicaid, to ensure contractual compliance and maximize reimbursement outcomes
- Utilized data analysis skills to identify trends in AR data, ensuring timely payments from diverse dental insurance providers
- Orchestrated the preparation of monthly revenue cycle reports, carefully analyzing denials and reimbursement accuracy to optimize financial performance
Medical Insurance Representative
UIC College of Dentistry
11.2017 - 06.2019
- Processed daily claims submissions within the EHR, skillfully reconciling submissions with clearinghouse records and insurance companies
- Demonstrated an agile approach in appealing insurance denials, successfully gathering supporting documentation and resubmitting for timely payment
- Applied advanced adjustments, efficiently managing insurance payments and ensuring accurate account balances for patients
- Maintained exceptional customer service standards, communicating with internal teams and external stakeholders via various channels
Education
Master of Science - Health Informatics, Concentration: Healthcare Data
University of Illinois At Chicago
Chicago, IL05.2023
Bachelor of Science - Health Informatics And Information Management
Florida Agricultural And Mechanical University
Tallahassee, FL08.2015
Skills
- Appeals handling
- HIPAA compliance
- Claims processing
- Microsoft Excel proficiency
- Insurance verification
- Denial management
- Medicaid/Medicare/Commercial Insurance Expertise
- Revenue cycle management
- ICD-10 coding/CPT Codes
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Multitasking
- Claims investigation
- Project management
- Data Analytics
- Auditing
- Accounts Receivable/Payable
- Prior Authorization
- Tableau
- Visio
- TEM
- P-card
- UPS CampusShip
- Change Healthcare
- Insurance Portals (DentaQuest, Avesis, Mediportal, etc)
- Eddie
- Dental Connect
- PNC
- Axium
- NEA Fast Attach
- RT Ticket System
- EpicCare/ Epic Resolute
- TDX
- Availity
- EviCore
Certification
- Licensed AHIMA-Registered Health Information Administrator (RHIA)
Timeline
Healthcare Reimbursement Analyst II/BMT Financial
UI Health
07.2024 - Current
Healthcare Reimbursement Analyst I
UIC College of Dentistry
03.2022 - 07.2024
Medical Insurance Associate
UIC College of Dentistry
06.2019 - 03.2022
Medical Insurance Representative
UIC College of Dentistry
11.2017 - 06.2019
Master of Science - Health Informatics, Concentration: Healthcare Data
University of Illinois At Chicago
Bachelor of Science - Health Informatics And Information Management
Florida Agricultural And Mechanical University
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