Melody Crawford Email and Phone Number

Promoted to authorize, deny, or send for review, a high-volume of appeals through email correspondence for a global health service company offering health, pharmacy, dental, supplemental insurance and Medicare plans to individuals, families, and businesses.• Review external appeals from healthcare professionals and customers relating to medical and behavioral treatment.• Assessed accuracy of claims to determine if claim was paid correctly or requires adjustment.• Send formal… Show more Promoted to authorize, deny, or send for review, a high-volume of appeals through email correspondence for a global health service company offering health, pharmacy, dental, supplemental insurance and Medicare plans to individuals, families, and businesses.• Review external appeals from healthcare professionals and customers relating to medical and behavioral treatment.• Assessed accuracy of claims to determine if claim was paid correctly or requires adjustment.• Send formal letters explaining appeals that are upheld and/or authorize appeals to be adjusted correctly.• Make adjustments on overturned appeals or send correspondence to appropriate department.• Research appeals using standard operating procedures, claim payment, state and federal regulations in IComply and other operating systems.• Manage personal inventory along with aging cases by use of daily reports.• Prepare and route appeals requiring clinical review to appropriate RN, Ph.D, or MD level clinical team. Show less

Promoted to handle inbound calls to educate callers on benefits, and handle referrals, escalations, and crisis situations.• Educated participants on their benefits and provided clinical/non-clinical resources.• Completed crisis intake and registered members for benefits while maneuvering between multiple systems.• Wrote authorizations to ensure claims were paid correctly.• Determined effective coverage dates to help resolve escalated benefit issues.• Attended all… Show more Promoted to handle inbound calls to educate callers on benefits, and handle referrals, escalations, and crisis situations.• Educated participants on their benefits and provided clinical/non-clinical resources.• Completed crisis intake and registered members for benefits while maneuvering between multiple systems.• Wrote authorizations to ensure claims were paid correctly.• Determined effective coverage dates to help resolve escalated benefit issues.• Attended all necessary trainings and seminars to stay updated on new processes.• Provided high quality customer service and met department metrics Show less

Provided accurate information to callers demonstrating courtesy and professionalism in all interactions.• Conducted outbound calls to customers to explain ongoing medical benefits for pre / post hospital stay.• Assisted with enrollment in wellness coaching and various other behavioral and medical projects.• Performed data entry utilizing EMR; updated and recorded customer medical inventory.• Scrubbed medical records to identify high cost claim users and assigned cases… Show more Provided accurate information to callers demonstrating courtesy and professionalism in all interactions.• Conducted outbound calls to customers to explain ongoing medical benefits for pre / post hospital stay.• Assisted with enrollment in wellness coaching and various other behavioral and medical projects.• Performed data entry utilizing EMR; updated and recorded customer medical inventory.• Scrubbed medical records to identify high cost claim users and assigned cases accordingly to their designated team. Show less

Empower Black and Brown communities to elevate their voice to build power. To advocate for equitable outcomes by changing policies and challenging oppressive systems.

Provided support services to help people to recover from the serious effects of mental illness and chronic health problems for one of the largest nonprofit health care organizations in the United States, serving metro St. Louis, mid-Missouri and Southern Illinois.• Provided clinical case management, education and support to 25 adults with severe mental illness, renal disease and other health related issues; completed timely documentation of treatment plan interventions and… Show more Provided support services to help people to recover from the serious effects of mental illness and chronic health problems for one of the largest nonprofit health care organizations in the United States, serving metro St. Louis, mid-Missouri and Southern Illinois.• Provided clinical case management, education and support to 25 adults with severe mental illness, renal disease and other health related issues; completed timely documentation of treatment plan interventions and outcomes.• Conducted treatment plan assessments with SMART goals, adhered to documentation processes to improve overall health and wellness of clients, monitored medication, and assisted with enrollment into disability and Medicare benefits.• Assisted with facilitating and co-facilitating health and wellness groups to educate clients on maintaining a healthy lifestyle while dealing with mental illnesses and co-occurring substance abuse.• Provided coverage in the absence of Case Managers. Show less

Assisted teachers in providing students with special needs in the STEP program to help them reach their fullest potential at a nationwide leader in providing special education services and technical education.• Developed curriculum and provided academic assistance in one-on-one and group settings to teach life skills to 16 - 18-year-olds; worked collaboratively with administration, teachers, parents/guardians and students.• Utilized effective classroom management techniques and… Show more Assisted teachers in providing students with special needs in the STEP program to help them reach their fullest potential at a nationwide leader in providing special education services and technical education.• Developed curriculum and provided academic assistance in one-on-one and group settings to teach life skills to 16 - 18-year-olds; worked collaboratively with administration, teachers, parents/guardians and students.• Utilized effective classroom management techniques and maintained accurate records on the progress of each student.• Identified and selected different instructional resources and methods to meet students’ varying needs. Show less