Michelle Gilliam

Assisted seniors with scheduling healthcare appointments, coordinating with providers, and arranging patient transportation for over 100 healthcare facilities while following call guidelines. Maintained 80–90% quality evaluation results using electronic health records and facility-specific scheduling/transportation protocols.

Retained up to 20% of patients through daily outbound calls to secure and schedule in-home doctor visits. Used AI for call scripting and rebuttals and applied coaching strategies to improve call outcomes and customer interactions.

Coached representatives supporting pharmacy benefit management operations, including insurance claims, prior authorization workflows, HIPAA compliance, and payer documentation requirements. Led the team to Tier 1 quality and reliability KPIs, earning Pay for Performance bonuses for 5 months, and delivered virtual coaching using Microsoft Teams and data-driven insights from pivot tables.

Advocated for up to 50 patients daily by calling healthcare providers to recommend tailored billing and coding solutions for medical claims and supporting members through prior-authorization approval. Managed the insurance claim lifecycle from denial through resolution, completed second-level appeals, collaborated to obtain supporting documentation, and increased approval rates to 80–85%.

Activities and societies: Inducted into the National Technical Honor Society.

Completed a certificate program in administrative office technology and medical billing and coding, covering medical terminology, anatomy and physiology, coding classification systems, EHRs, medical billing procedures, compliance, and health information management systems. Inducted into the National Technical Honor Society for demonstrated student performance and leadership.

Completed a remote certificate in digital leadership focused on AI and digital technology opportunities and challenges, developing and communicating vision and strategy.