Melissa Strait Email and Phone Number

Managing contracts that support the dental government business, as well as the staff that support the contracts. Responsibilities including managing daily operational activities for enrollment and billing, claims, including foreign claims, and customer service telephone, written and appeals. Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; oversees accuracy of internal and government reporting, data, assists with budget development and tracks monthly expenses to ensure budget compliance. Oversees the training program to ensure training course content is complete, current, and meets the initial and ongoing cross-training instruction needed to service multiple contracts with competency and accuracy.Develops plans of action and provides manager support to utilize effectively workforce management tools and reports to ensure all timeliness and accuracy requirements are met for enrollment/billing, claims, customer service telephone and written/appeals are met for all contracts (TDP, ADDP and FHFA).

• Analyze processes to support Health Plan Operations areas by conducting impact analysis to aid in decision making and problem resolution.• Support various task surrounding Coordination of Benefit and Financial Recovery error resolution. • Utilize project management methodologies, as an individual contributor and/or project lead to produce project deliverables such as assisting with developing and defining detailed requirement, participating in the functional design, testing and implementation of small/medium projects related to Other Party Liability. • Support various levels of testing, such as parallel, positive, negative, business integration, regression, and partner testing. Analyze defects and provide business impacts and resolution.• Track, trend, forecast and analyze data to identify potential inaccuracies.• Create process data models, work flows and functional use cases. • Maintenance and development Business documentation and conduct training. • Produce and distribute Client Coordination of Benefit and Medicare Detail reports• Support the OPIS Member Maintenance process.• Support and respond to Internal Audit request related to Coordination of Benefit and Financial Recovery.• Assist with additional assigned task within the department accountabilities.

Effectively decreased the days on hand for inventory by 33%, without overtime and positions filled. Established good foundational relationships with internal/external departments/vendors.Effectively completed process improvements to save time and streamline processes that benefit the customer, member and our vendors. Effectively supervised and streamlined assignments/tasks assigned to individual employees and transferred those job duties to the appropriate employee. Created new TeamSite page, rewrote and streamlined all processes within the Financial Recovery/Vendor Recovery Area. Created and implemented the Daily inventory report.

Effectively supervised/supported premium billing of approximately $50 million a month, accounts receivables aging, government enrollment and premium reconciliation, and delinquency processing.Exceeded goals and contractual requirements for quality and timeliness of servicing incoming member calls, processing enrollment applications, mailing ID cards, and processing written inquiries for five consecutive years.Effectively supervised and streamlined current positions which resulted in eliminating positions, reduced staffing 24% in four years despite an 11% increase in enrollment and a 16% increase in call volumes. Successfully supported implementation of ISO 9001 and Sarbanes-Oxley/Model Audit Rule requirements and ensured compliance with HIPAA and other regulations.Achieved significant cost savings and productivity increases through working collaboratively with department employees and others throughout the organization to develop and implement workflow improvements, implement automation and system enhancements, reduce after call work and increase agent availability.Coordinated an effort to improve the voicemail process which notified members that a voicemail option is available after 90 seconds of hold time and gives the caller the choice of continuing to hold or to leave a message and receive a callback.Reviewed and streamlined the returned refund checks process which increased processing timelines and reduced the cost of stop pays and reissues. Developed and streamlined the management review case process which reduced the paper trail and improved availability of representatives.