Melanie Lynne, COTA/L, BSHIM, RHIA
Roanoke,VA
Summary
Seasoned Provider Relations Manager committed to maintaining high customer satisfaction by providing friendly, fast service for all needs. Skillful in researching and resolving billing discrepancies and claims. Disciplined and energetic professional well-versed in medical claim appeal processing, clinical relations and medical billing. Posses in-depth knowledge of various insurance plans and policies. Expertise in handling a high volume of calls, efficiently resolving disputes and identifying ways to improve processes. Proficient in Salesforce and HRP. Communicative and detail-oriented individual with excellent interpersonal abilities.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Provider Relations Manager
PCHP Insurance
01.2022 - Current
- Served as liaison between healthcare providers and internal departments such as claims processing or customer service, facilitating effective resolution of any issues that arose during day-to-day operations.
- Reviewed expenses and fund allocations for accounts at regular intervals to verify credited surplus and deficits based on payment schedules and claim submissions.
- Contributed to and enhanced audit processes to maximize quality management standards.
- Analyzed data from various sources to identify trends, anticipate future needs, and inform strategic planning efforts related to provider relations.
Patient Access Representative
Centra
01.2021 - 01.2022
- Identified insurance payment sources and listed payers in proper sequence to establish chain of payment.
- Maintained accurate patient records, contributing to well-organized database for seamless information access across departments.
- Managed challenging situations effectively by remaining calm under pressure while resolving conflicts or addressing dissatisfied patients professionally.
Licensed, Certified Occupational Therapy Assistant
Pittsylvania County Schools
07.2018 - 05.2021
- Educated patients and families on conditions, treatments, and home exercises.
- Served as a source within the occupational therapy community by mentoring students completing fieldwork experiences. Educated patients on safe and effective use of therapy equipment, such as adaptive techniques and inclined surfaces.
- Trained new Certified Occupational Therapy Assistants and students, resulting in improved team performance and productivity.
Assistant Rehab Director |Activities Director
Medical Facilities of America
01.2013 - 01.2016
- Extensive experience with geriatrics at SNF, Home Health, Inpatient/Outpatient, Hospital and Assisted Living Facilities
- Demonstrated effectively leading team of 15 therapist employees and operational units
- Assisted head manager with daily managerial duties, participated in administrative committees/budgets, and was lead manager for face-to-face exceptional customer service with site management on complex issues with patients or families
- Lead team therapist to include setting performance and productivity standards and team goals and ensuring achievement of those goals through effective management
- Manage continuous improvement efforts to better business results including encouraging and motivating the team effectively by providing coaching and feedback on personal performance, accountability, and department goals, and identifying development opportunities regarding personal and professional growth
- Mentor therapy students and therapy staff for further professional development, to meet and exceed service goals and increase productivity, with the result of delivering quality service efficiently.
- Oversaw operations and provided corrective feedback to achieve daily and long-term goals.
Education
Bachelor of Science - Healthcare Information Management
Western Governors University
Salt Lake City, UT04.2023
Associate of Science - Occupational Therapy
Jefferson College of Health Sciences
Roanoke, VA05.1996
Skills
- Performance Evaluations
- Project Planning
- Team Development
- Strategic Business Relationships
Certification
- Licensed Certified Occupational Therapy Assistant
- Registered Health Information Administrator (RHIA)
Timeline
Provider Relations Manager
PCHP Insurance
01.2022 - Current
Patient Access Representative
Centra
01.2021 - 01.2022
Licensed, Certified Occupational Therapy Assistant
Pittsylvania County Schools
07.2018 - 05.2021
Assistant Rehab Director |Activities Director
Medical Facilities of America
01.2013 - 01.2016
Bachelor of Science - Healthcare Information Management
Western Governors University
Associate of Science - Occupational Therapy
Jefferson College of Health Sciences