Michelle Apeanyo
Health Informatics Professional
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About
Dynamic health informatics professional with a strong background in utilization management, prior authorization, clinical informatics, and healthcare operations. Experienced in handling high-volume inbound/outbound calls and fax-based authorization workflows within fast-paced call center environments. Skilled in reviewing medical necessities, interpreting CPT, ICD, and HCPCS codes, and supporting commercial healthcare plans and utilization review processes.
Proficient in clinical data analysis, workflow optimization, and care coordination, with exposure to Guiding Care.
Experience
Behavioral Health Specialist - Well Sense - Boston, MA
(2026-01 - 2026-09)
- Investigated benefit discrepancies, coding issues (ICD‑10, CPT, HCPCS), and care gaps; documented findings
- Conduct comprehensive behavioral health assessments to identify member needs, barriers to care, appropriate disposition, and level-of-care recommendations across Mental Health and SUD services.
- Coordinate admissions, transfers, referrals, and transitions of care with physicians, nurses, inpatient psychiatric units, community providers, and insurance partners.
- Support payer workflows including eligibility, benefits, prior authorization, utilization management, care coordination, and clinical documentation.
- Review clinical records and documentation for medical necessity, level-of-care recommendations, authorization decisions, and compliance with payer and regulatory requirements.
- Maintain accurate, timely, and audit-ready documentation in Jiva while adhering to HIPAA, regulatory, contractual, and accreditation standards.
- Collaborate with clinical, provider, operations, QA, and technology teams to identify workflow gaps, improve processes, and support Substance Abuse/behavioral health quality initiatives.
- Utilize Facets, Guiding Care, Jiva, Excel, and SQL to manage healthcare data, analyze referral and utilization trends, support workflow optimization, and develop operational reports.
- Support UAT, workflow validation, gap analysis, and process improvement activities while translating clinical and operational needs into effective healthcare workflows.
Behavioral Health Care Coordinator - Blue Cross Blue Shield - Chicago, IL
(2022-11 - 2025-05)
- Translate complex weekly behavioral health data such as patient risk scores, treatment effectiveness, care gaps, and patient engagement metrics to improve decision-making for care management.
- Clinical data management
- Conduct comprehensive reviews of behavioral medical records and ensure compliance with clinical guidelines to support quality improvement initiatives and patient care outcome.
- Support utilization review processes by gathering clinical documentation, verifying benefit coverage, and preparing cases for clinical escalation.
- Collaborate with Behavioral Health and Physical Health teams daily to enhance treatment workflows, identifying and resolving bottlenecks to optimize processes.
- Generate weekly clinical, population health, and quarterly performance reports and analysis to support operational efficiency and performance improvements.
- Conduct daily data analysis on caseload metrics to enhance operational efficiency.
Case Manager - The Bowen Center - Elkhart, IN
(2021-04 - 2022-02)
- Developed personalized care plans for approx. 12 Medicaid clients by synthesizing clinical and claims data.
- Analyzed patient data trends to inform workflow quality of care improvements and service delivery enhancements.
- Ensured accurate and compliant documentation aligned with legal, ethical, and clinical standards, optimizing record-keeping process.
- Partnered with stakeholders such as healthcare providers, behavioral health organizations, and government agencies to deliver integrated, patient-centered care solutions.
Student Researcher - Indiana University - South Bend, IN
(2021-03 - 2021-12)
- Conducted advanced data analysis using IBM SPSS and presented insights in statistical reports.
- Designed and programmed research surveys in Qualtrics, ensuring high-quality data collection and integrity.
- Documented workflows and maintained strict quality control standards throughout research projects.
Research Assistant - Department of Sociology, South Suburban College - South Holland, IL
(2016-08 - 2018-05)
- Spearheaded survey design and analysis initiatives, leveraging SPSS to extract actionable insights.
- Presented findings to diverse stakeholders, emphasizing clinical and operational implications.
- Maintained detailed records and ensured alignment with project objectives and regulatory compliance.
Education
Master of Science - Health Informatics - University of Illinois Chicago (2026)
Bachelor of Arts - Psychology; Minor: Counseling - Indiana University South Bend
