ALISA M. MELOCHE
Delanson,NY
Summary
Experienced healthcare operations professional with over 10 years in managed care, Medicaid/Managed Long-Term Care, and regulatory compliance. Skilled in documentation auditing, authorization processing, and provider communication, with a solid grasp of payer processes. Proficient in healthcare systems including Salesforce and electronic medical records, delivering accurate documentation and resolving complex issues efficiently.
Overview
1
1
Certification
15
15
years of professional experience
Work History
Owner / Operator
ALISA MELOCHE'S FAMILY DAYCARE
Delanson, NY
08.2019 - Current
- - Manage all administrative, financial, operational, and regulatory functions of a licensed business, maintaining accurate records and documentation required for ongoing compliance.
- - Maintain billing records, contracts, attendance records, financial documentation, policies, reports, and other confidential business information.
- - Manage client billing, payment questions, contracts, scheduling, and account-related issues.
- - Conduct regular reviews of records and procedures to identify discrepancies and ensure compliance with applicable state requirements.
- - Prepare documentation for regulatory inspections and maintain organized records to support compliance reviews.
- - Use Microsoft Excel for budgeting, financial tracking, reporting, and record management.
- - Train and supervise staff, monitor adherence to established procedures, and address documentation or operational issues.
- - Communicate professionally with clients regarding policies, financial obligations, documentation, and resolution of concerns.
Program Associate Supervisor
FIDELIS CARE / CENTENE
Latham, NY
01.2018 - 01.2019
- - Supervised a team of Service Coordinators supporting Medicaid Managed Long-Term Care (MLTC) members with insurance verification, authorizations, benefit information, case documentation, and care coordination.
- - Trained and coached Service Coordinators on documentation standards, benefit information, and authorization procedures to ensure compliance.
- - Reviewed case documentation for accuracy, completeness, and compliance with quality and operational requirements, ensuring adherence to standards.
- - Monitored quality and audit results, identified documentation errors, and collaborated with staff to enhance accuracy and compliance.
- - Conducted case reviews and analyzed eligibility, coverage information, authorizations, benefit requirements, and member-specific circumstances.
- - Interpreted plan benefits, policies, procedures, and authorization requirements when assisting staff with complex cases.
- - Researched complex member and provider questions and coordinated resolution with appropriate internal departments.
- - Maintained confidential member information and ensured staff followed established documentation and privacy requirements.
Service Coordinator
FIDELIS CARE
Latham, NY
01.2016 - 01.2018
- - Verified insurance eligibility and benefits and processed authorizations for Medicaid Managed Long-Term Care members to ensure access to necessary services.
- - Resolved member and provider inquiries regarding benefits and authorizations, enhancing care coordination and satisfaction.
- - Reviewed member, provider, and plan information to determine applicable coverage and service requirements, facilitating informed care decisions.
- - Communicated daily with members, physicians' offices, healthcare providers, and internal departments regarding coverage and authorization requirements.
- - Maintained detailed case notes and updated Salesforce and other case-management systems with accurate case-specific information.
- - Used Salesforce, Microsoft Excel, and ePACES to maintain case information, track cases, calculate eligibility, and prepare reports.
- - Conducted monthly documentation audits to verify accuracy and completeness of records.
Scheduling Coordinator
VISITING NURSES HOME CARE
Menands, NY
01.2015 - 01.2016
- - Coordinated scheduling and insurance authorizations for home healthcare services, ensuring timely delivery of care.
- - Reviewed authorization information and service requirements, enhancing accuracy in scheduling and documentation.
- - Addressed patient, staff, and provider inquiries regarding services, schedules, and authorization-related issues, facilitating effective communication.
- - Maintained accurate payroll and HR records and prepared reports related to staffing and compliance requirements.
- - Worked within established healthcare, staffing, overtime, and documentation regulations.
Medical Assistant / Dental Assistant / Front Desk Coordinator
NEW DIMENSIONS IN HEALTH CARE
Amsterdam, NY
01.2014 - 01.2015
- - Verified insurance coverage and secured authorizations for medical and dental services, ensuring timely patient access to care.
- - Reviewed patient and insurance information, maintaining accurate electronic medical records to support effective patient management.
- - Processed prior authorization documentation and communicated coverage requirements to patients and providers, facilitating informed care decisions.
- - Prepared department reports and maintained accurate patient and insurance documentation.
- - Coordinated patient appointments with healthcare providers to optimize scheduling efficiency. and coordinated communication among patients, providers, and office staff.
Patient Care Technician
DAVITA DIALYSIS
Vernon, CT
01.2012 - 01.2014
- - Maintained accurate patient documentation in accordance with healthcare standards and facility procedures.
- - Coordinated patient scheduling and communicated treatment information to enhance patient understanding.
- - Supported facility audits to ensure compliance with healthcare protocols.
- - Trained staff on operational processes and managed supply inventory to support facility efficiency.
Education
Medical Assistant - Medical Assistant
Porter And Chester Institute
Enfield, CT01-2011
College Coursework -
Fulton-Montgomery Community College
Johnstown, NYSkills
- - Claims support
- - Managed Medicaid / MLTC
- - Insurance & Eligibility Verification
- - Authorization processing
- - Case Review & Research
- - Provider Communication
- - Record documentation
- - Quality assurance
- - Policy interpretation
- - Issue Resolution
- - Regulatory compliance
- - Data Entry & Accuracy
- - Microsoft Excel / Word / Outlook
- - Salesforce
- - ePACES
- - Electronic Medical Records
- - Staff Training & Supervision
- Microsoft Excel
- Microsoft Word
- Microsoft Outlook
- Salesforce
- EPACES
- Electronic Medical Records (EMR)
- Case management systems
- Case documentation
- Authorization processing
- Salesforce reporting
- Compliance tracking
- Healthcare coordination
- Records management
- Regulatory compliance
- Audit preparation
- Attention to detail
- Billing administration
- Effective communication
- Problem solving
- Leadership skills
- Process improvement
- Program records management
- Administrative tasks
- Financial oversight
- Regulatory review
- Cross-functional collaboration
- Calendar management
- Organizational multitasking
- Community outreach
- Report writing
- Remote working experience
- Collaborative teamwork
Personal Information
Title: HEALTHCARE OPERATIONS | CLAIMS & AUTHORIZATION SUPPORT | QUALITY & COMPLIANCE
Certification
- Certified Clinical Hemodialysis Technician, 2013, - CPR & First Aid Certified, - NYS Registered Family Day Care, - Fire & Safety Clearance / Regulatory Compliance / OCFS, - NYS Foster Care Licensed/Certified, - Excel I & II, - Managing Remote Teams, - Stepping Up to Management, - Management Quick Start, - Conducting Effective Interviews, - Performance Management
Timeline
Owner / Operator
ALISA MELOCHE'S FAMILY DAYCARE
08.2019 - Current
Program Associate Supervisor
FIDELIS CARE / CENTENE
01.2018 - 01.2019
Service Coordinator
FIDELIS CARE
01.2016 - 01.2018
Scheduling Coordinator
VISITING NURSES HOME CARE
01.2015 - 01.2016
Medical Assistant / Dental Assistant / Front Desk Coordinator
NEW DIMENSIONS IN HEALTH CARE
01.2014 - 01.2015
Patient Care Technician
DAVITA DIALYSIS
01.2012 - 01.2014
Medical Assistant - Medical Assistant
Porter And Chester Institute
College Coursework -
Fulton-Montgomery Community College