Melissa C. Email & Phone Number

Houston, Tx, Us

London, Greater London, Gb

Arlington, Va, Us

Oversee health plan enrollments for 5,500+ providers across a complex network of TINs, provider types, and service lines ensuring compliance with regulatory requirements, NCQA delegation, growth plans, and timelines. Collaborate with stakeholders on new market expansions in the Mid-Atlantic, Northwest, South, and Western regions. System Administrator and SME for Verity CredentialStream. Develop intuitive workflow automation, advanced reports, and data-driven trackers incorporating live claims data resulting in increased revenue. Design training materials applying systematic instructional design to create learning curricula, facilitation guides, case scenarios, checklists, and other blended learning assets. Streamline launch of government, delegated, and non-delegated managed care enrollments. Manage claim holds and denials using athenaNet.

Atlanta, Georgia, Us

Oversight of credentialing, affiliation, privileging, and enrollment teams for 450+ providers across multiple TINs for Anesthesia, Ancillary Services, and Gastroenterology service lines within Georgia and Florida.System Administrator and SME for Verity CredentialStream. Successfully implemented new credentialing software within a three-month timeline. Digitized manual facility credentialing and privilege process by developing advanced forms mapping and SOPs to ensure compliance with regulatory standards under CMS, TJC, AAAASF, and AAAHC standards. Showcase software enhancements and provide support and training to stakeholders. Maintain professional change management during 17 planned integrations within one year. Increased revenue by creating data-based trackers to resolve enrollment gaps using eClinicalWorks and PowerBI.

Atlanta, Georgia, Us

Oversight of credentialing, privileging, and enrollments for 250+ highly subspecialized radiology and neuroradiology providers and radiologic technologists across multiple TINs within 30+ joint ventures and independent diagnostic testing facilities across Alabama, Florida, Georgia, and Texas.System Administrator and SME for Echo OneApp. Configured intuitive automation reducing credentialing and enrollment timelines by 50%. Implemented a single source of truth by cataloging chargemaster, code listing, fee schedules, scheduling guidelines, and payer contract inventory. Distribute key deliverables and executive summaries for CMS Proposed and Final Rules, MACRA, MIPS, and Quality Measures. Project Manager for CMS Appropriate Use Criteria, CAQH CORE, and CMS 5010 claim edits.

Greenwood Village, Colorado, Us

Collaborate with Audit Committee and KPMG on the creation of SOx-compliant policies and procedures. Project Manager for Federal Section 1011 and CMS Condition Codes. Coordinated with FEMA and the Department of Defense during hurricanes Cindy, Dennis, Katrina, and Rita to identify disaster victims for the Hardship Committee. Launched training for 5,000+ healthcare and military personnel providing air medical services across a fleet of 450 helicopters and fixed-wing aircraft.

Greenwood Village, Co, Us

Reduced bad debt by insourcing payer collections. Coordinated efforts with FEMA and EMS during the 9/11 attack by identifying disaster victims for the Disaster Relief Committee. Served 2,100+ communities in 40+ states, 3+ million patients annually, and 8,000+ practitioners.

Bachelor Of Science - Bs, Interdisciplinary Social Sciences

Liberal Arts

Associate Of Science - As, Human Nutrition, Pre-Dietetics

Associate'S Degree, Healthcare Administration