Melissa Boyer Email & Phone Number

Beaver Falls, Pa, Us

-Works with Business Partners on work procedures including but not limited to proper correspondence -and call handling and maintaining quality standards.-Provides feedback and acts as subject matter expert in addressing procedural issues.-Partners with Business Partners to ensure targeted training and mentoring for front-line staff. -Utilizes available software/hardware applications promoting “reinforcement coaching” for staff. -Reports on performance results and may provide support to Business Partners in the development of action plans for staff and effectiveness.-Monitors the participation and reports inventory for business activity and completes appropriate follow-up. -Provides technical and subject matter expertise relative to policies, procedures, and customer service applications/systems tools.-E2E quality tester.-Project management related to Network and Medicare Appeals.-Performs final level call reviews for escalations.

Interface with customers via telephone, written correspondence, fax, web, and e-mail to respond to routine inquiries and resolve concerns regarding claim adjudication and payments, member benefits, premium payments, eligibility, authorization requests, and coordination of benefits. Research claim processing inquires and provider contracts. Resolve escalated issues as an acting supervisor. Provide peer to peer guidance on challenging issues. Complete claim adjustments as well as investigating, analyzing, and resolving outstanding issues to obtain customer satisfaction. Special system project coding and converting ICD 9 codes to ICD 10 across a system wide application. System content manager. Maintain all compliance standards with relation to HIPAA, The Affordable Care Act, and CMS guidelines. Research credentialing requests and verify information updated with CAQH. Experience in both Medicare and Commercial lines of business including group, individual, and Marketplace plans as well as serving as a credentialing liaison. Assist as a colleague mentor. Experience with both medical and dental lines of business. Team meeting facilitator. E2E system quality tester.

Transcribe, create, proofread, and mail all correspondence along with customer service, appointment scheduling, and insurance verification.

Data entry, customer service, special projects including but not limited to hospital chart analysis, letter composition for upper management, and record retrival.

Create compositions with various group sizes and age ranges to maximize sales. Develop unique portrait creations.

Bachelor Of Arts (B.A.), English Literature And Creative Writing

Activities and Societies: Resident Assistant, Student Government Secretary, Student Activities Board Secretary, Yearbook Editor in Chief.

Education record