MELINDA SIMMONS
Summerville,SC
Summary
Dedicated and results-driven Risk Management Specialist with 18 years of extensive experience in the healthcare industry. Expert in identifying, analyzing, and mitigating risks in healthcare settings, ensuring patient safety, regulatory compliance, and operational efficiency. Skilled in developing comprehensive risk management strategies, implementing effective risk control measures, and fostering a culture of proactive risk management. Proven ability to enhance organizational resilience, protect assets, and improve overall healthcare quality and safety.
Overview
18
18
years of professional experience
Work History
Risk Management Specialist
Advantage Care Physicians
01.2015 - Current
- Conduct comprehensive risk assessments for patient safety and regulatory compliance
- Develop strategies to mitigate risks and establish patient safety protocols
- Formulate and update risk management policies aligned with healthcare standards
- Manage incident reporting and investigations to enhance patient safety
- Collaborate across teams to integrate risk management into daily operations
- Analyze risk assessment data to drive proactive risk mitigation strategies.
- Investigated allegations to check validity and recommend actions to minimize risk
- Developed short-term goals and long-term strategic plans to improve risk control and mitigation
- Reviewed contracts and agreements to identify potential risks and ideal mitigation strategies
- Supported 20 member risk management team with multifaceted in organizing and transmitting records
- Taught employees how to control risks at front line
Professional Liability Administrator
Health Partners
01.2009 - 01.2015
- Manage 30+ professional liability insurance policies including new applications, renewals, and payments
- Investigate professional liability occurrences independently, assessing standard of care issues
- Develop risk management strategies, including tools, modules, and educational seminars
- Generate monthly and quarterly risk management reports to support organizational initiatives
- Conduct facility security evaluations during monthly walkthrough inspections
- Maintain accurate records and ensure compliance with insurance policies and regulations.
Central Brooklyn Medical Group
01.2006 - 01.2009
- Conduct comprehensive audits of medical records for accuracy and regulatory compliance
- Identify coding errors and discrepancies using knowledge of medical coding and billing practices
- Assess compliance risks within medical records and billing processes
- Develop and implement policies and corrective action plans based on audit findings
- Perform follow-up audits to evaluate the effectiveness of implemented corrective actions
- Educate and train medical staff on coding guidelines, compliance requirements, and best practices.
- Excellent communication skills, both verbal and written
Education
Associate of Science – AS - Health/Health Care Administration/Management
Southern New Hampshire University
New Hampshire, OH2021
Some College (No Degree) - Certified, Medical Billing And Coding
Sanford Brown Institute
United States Army
2001
Skills
- Skills & Abilities
- Strong written and verbal communication skills
- Exceptional customer service and interpersonal skills
- Accurate data entry and attention to detail
- Effective organizational skills for records management
- Independent and collaborative team player
- Quick learner with adaptability to new systems
- Efficient time management to meet deadlines
- Strong analytical and problem-solving abilities
- Proficient in
- EPIC Systems, RL6, Navient, NextGen, and Oracle
- Advanced Microsoft Office skills (Excel, Word)
- Thorough understanding of HIPAA regulations
- Experience with Crystal Reports and HEDIS benchmarks
Timeline
Risk Management Specialist
Advantage Care Physicians
01.2015 - Current
Professional Liability Administrator
Health Partners
01.2009 - 01.2015
Central Brooklyn Medical Group
01.2006 - 01.2009
Associate of Science – AS - Health/Health Care Administration/Management
Southern New Hampshire University
Some College (No Degree) - Certified, Medical Billing And Coding
Sanford Brown Institute
United States Army