Melanie Fields Email & Phone Number

Las Vegas, NV, US

Remote

• Manage the operational execution of the auditing program by working with the client operational managers, provider services managers, network managers, claims managers, member services managers, and IT managers.
• Lead analysts responsible for day-to-day operational performance
• Serve as client facing POC and operational SME for assigned clients
• Develop/manage projects, process improvements, and strategic initiatives consisting of cross functional teams
• Participate in the sales process for the purpose of ensuring contract term expectations result in a successful client experience
• Assist with the HMS/Gainwell/Cotiviti transition team to ensure integration of acquisition and coverage of all accounts

Remote

• Managed Medicare Advantage, Medicaid, and Commercial LOBs for large Blues Health Plans
• Responsible for developing, managing, and retaining client relationship and revenue across assigned book of business
• Delivered regular reporting on program utilization and risk improvement to ensure client specific goals were being met and to provide proactive recommendations during program execution
• Identified and corrected operation inefficiencies, resulting in additional revenue
• Worked cross-functionally to meet and exceed our commitments to our clients on execution and value delivered
• Assisted with project management and facilitation of implementations, operations, and troubleshooting/issue resolution

Las Vegas, Nevada, United States

• Managed Medicare Advantage, Medicaid, and Commercial LOBs for large Blues Health Plans
• Responsible for developing, managing, and retaining client relationship and revenue across assigned book of business
• Delivered regular reporting on program utilization and health risk improvement to ensure client specific goals were being met and to provide proactive recommendations during program execution
• Identified and corrected operation inefficiencies, resulting in additional revenue
• Worked cross-functionally to meet and exceed our commitments to our clients on execution and value delivered
• Assisted with project management and facilitation of implementations, operations, and troubleshooting/issue resolution

Remote

• Work alongside the Implementation team to kick start new client workflows in accordance with project plan requirements.
• Support production accounts by analyzing and assessing the performance of business processes for our current Payment Integrity products and work to enhance operational efficiency.

Las Vegas, Nevada, United States

• Responsible for the functional role of client letters – from implementation through mailing phase as well as medical record attachment and issues
• Monitored claim status inventory reports to ensure status flows were moving appropriately and timely
• Assisted the account management team with client data, correspondence, research, trouble shooting and ensured overall processes were working and deadlines were met as well as assisted with implementation functions
• Worked with Business Analysts and Production IT to improve technology applications and automate manual processes
• Assisted colleagues with accounts with regards to client relations, scope of work, troubleshooting, etc.

Las Vegas, Nevada, United States

• Provided assistance to account leadership including coordination of internal analytical, strategical and technical resources to deliver on client's needs and expectations
• Assisted in the facilitation of day-to-day client management and supported both the development and maintenance of strong client relationships
• Performed data validation, audited incoming and outgoing files, assisted in research for provider inquiries, interacted with IT Department to facilitate workflow
• Worked to understand the client's business needs and collaborated with the Account Operations team to ensure the implementation of analytical and technical solutions to enable those strategies
• Monitored the accuracy and flow of claims data by running daily reports
• Delivered against a scope of work that includes production schedules, results reporting and strategic development

Las Vegas, Nevada, United States

• Responsible for supervising provider service representatives for commercial clients; to include handling escalated calls and correspondence, ensured daily tasks were completed and that policies and procedures were.
• Provided training and guidance, managed employees breaks, lunches and personal time off
• Acted as a liaison between providers and the account management team

Las Vegas, Nevada, United States

• Responsible for supporting the CMS account management team
• Analyzed queries and result sets and loaded them into the database
• Created CMS Part B selection files and reviewed CMS offset files for accuracy and execute any changes
• Researched provider inquiries as well as reconciled errors

Anchorage, Alaska, United States

• Responsible for electronic claims submission and resolution of clearinghouse rejections
• Worked insurance and patient aging reports to reconcile unpaid accounts
• Initiated phone calls to insurance companies and patients to obtain reimbursement
• Wrote appeal letters for denied/incorrect payments and maintain adequate audit trail
• Processed electronic patient statements and mail Past Due and Final notices
• Access Credit Bureau information and review credit reports to determine patient’s financial status for payment arrangements or charitable programs

Anchorage, Alaska, United States

• Reviewed EOBs to determine how payments would be posted to patient accounts; applying contractual adjustments and created an action plan for incorrect payments
• Reviewed all correspondence and distributed to the appropriate team members/departments
• Maintained Medicare, Medicaid, and various PPO accounts within facility standards to include the review of payments, appealing incorrect payments and claim submission for corrected claims and/or secondary billings
• Worked in conjunction with other team members for account resolution

Cranberry, Pennsylvania, United States

Goldsboro, North Carolina, United States

Goldsboro, North Carolina, United States

Wexford, Pennsylvania, United States