Christopher Mele

• Mentor new employees November 2021-current
• Taking on additional responsibilities and client groups
• Responsible for conducting client bi-weekly Meetings via Microsoft TEAMS
• Discuss process and process improvements
• Joined Design Thinking Capability Academy (DTCA) January, 2022 and graduated July,2022
• Experience with CAQH database and multiple Payor online portals
• Commercial and Government payers
• Professional communication skills
• Forward-thinking and self-directed
• Meets and exceeds productivity standards/metrics
• Commitment to Individual, Team and Corporate goals.
• Troubleshot technical issues related to the online enrollment system, providing prompt resolutions for providers and internal stakeholders alike.
• Facilitated seamless transitions between different stages of the enrollment process by maintaining open lines of communication among various departments involved in provider services operations.

• Followed up with clients and insurances payors in accordance with established guidelines for all credentialing and re-credentialing assignments
• Assigned Providers (doctors, NP, PA) and Group accounts providing services in California (March 2021).
• Assigned large Client; CellNetix Pathology and CellNetix Labs in the State of WA and AK (November 2021)
• After 5 months of employment, (April 2021). Designated as a Peer advisor that would be able to assist new hires in areas of support.
• Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
• Enrolled providers with Commercial, Medicaid, Medicare, and private insurance plans.
• Safeguarded confidential provider information by adhering to strict data privacy regulations and company policies.
• Facilitated communication between departments, resulting in improved collaboration during the credentialing process.
• Demonstrated excellent problem-solving skills when confronted with complex issues or discrepancies during the credentialing process.
• Developed strong relationships with external organizations, leading to increased cooperation during verification processes.
• Expedited the onboarding process for new providers, ensuring timely completion of all required documentation and verifications.
• Ensured compliance with industry standards by regularly updating policies and procedures related to credentialing.
• Provided exceptional customer service to both internal and external stakeholders, addressing inquiries promptly and professionally.
• Assisted in training new employees on proper credentialing procedures, contributing to their rapid integration into the team environment.
• Contributed positively to team dynamics by fostering a collaborative and supportive work environment.
• Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.

Assigned Providers (doctors, NP, PA) and Group accounts providing services in the State of California (March 2021).

• Initiates communication as well as responds to inquiries on accounts for successful resolution of balances owed
• Prepares and maintain daily and monthly reports
• Identifies accounts with credit balances and processes refunds accordingly
• Clearly communicates any billing related concerns with management
• Maintains current knowledge of government regulatory, provider credentialing status as well as departmental and organizational policies.
• Collaborated with physicians to ensure accurate documentation of diagnoses and procedures for proper billing purposes.
• Expedited reimbursements with efficient follow-ups on outstanding claims and negotiating with insurance carriers.
• Reduced denied claims by maintaining up-to-date knowledge of insurance guidelines, coding practices, and compliance requirements.
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• Received and reviewed delinquent Hospital facility accounts to process and retrieve them from multiple insurance payors.
• Streamlined communication between internal departments, enhancing collaboration efforts toward shared objectives.
• Determined actions needed in resolving short payments from insurance payers.
• Maintained high level of professionalism while aggressively pursuing and overturning identified underpayments from insurance payers with timeliness and accuracy.
• Proactively followed up with third party payers regarding appeals submitted with effective communication both written and verbal.
• Analyze and interpret complex provider contracts, verifying their credentialing and payment methodologies for hospital-based reimbursement.
• Submitted appealed accounts on spreadsheets in reporting bi-weekly to insurance payers which we would meet monthly via conference call to discuss further questions or concerns.

• Completed Credentialing and Re-Credentialing Contracts for all Dental Providers in South Carolina
• Researched claim denials and resolved them in a timely manner
• Updated all files in local and national systems
• Reviewed all dental provider credentialing files which included dental license, malpractice insurance, and other required documentation to ensure records were current, accurate and up to date in all systems
• Completed 2017 Re-credentialing providers by end of 1st quarter 2018 which were behind 4 months when first started. Also cleaned up electronic files in all systems.
• Processed Taxpayer ID changes and updated all systems when dental providers retired, changed locations, and set up of new providers opening their own practice
• Processed incoming email, faxes, and regular mail daily from basic to complex questions and issues.
• Strengthened professional relationships by consistently maintaining open lines of communication and fostering collaboration among team members.

• Handled various incoming service calls from sales agents and plan administrators of large companies.
• Helped with agent inquiries for open enrollment, Coverage dates, coverage and benefit questions.
• Researched and helped provide answers on various benefit policies and procedures.
• Assisted plan administrator inquiries for billing discrepancies, reconciliation of invoices, and plan administrator website information.
• Provided general tax information on a group level as well as general claim inquiries from agents and group accounts
• Resolved potential discrepancies and ways to resolve them including communicating with internal and external departments.
• June 2014 - Assigned to 'Waiver of Premium refund' reports
• October 2014 - Joined Colonial Life's, Toastmaster's international.
• March 2015 - Joined multi-departmental Collaboration Team.

• Processed and researched patient accounts for a durable medical equipment company that provides sales and services to customers for the Southeast region
• Collected and processed premium payments received from primary and secondary medical insurance companies as well as primary and secondary Medicare, Medicaid and Medicare replacement
• Daily filing and monthly report preparation.