Melanie Milan
Bronx,NY
Summary
Results-driven provider relations specialist with expertise in provider communication, appointment scheduling, and claims processing. Demonstrated success in enhancing workflow efficiencies and ensuring compliance in dynamic healthcare settings. Strong ability to foster relationships and streamline operations for improved service delivery.
Overview
17
17
years of professional experience
Work History
Provider Relations Specialist
OptumHealth
New York, New York
04.2021 - 02.2023
- Facilitated communication between healthcare providers and OptumHealth teams to resolve issues and enhance collaboration.
- Collected and verified up-to-date provider and patient information to ensure accuracy in records.
- Confirmed and scheduled appointments to ensure seamless patient access to care.
- Answer incoming calls promptly and courteously
- Distributed and followed up on escalated and urgent surgery cases to expedite resolution and improve patient outcomes.
Quality Assurance Analyst
OptumHealth
New York, New York
03.2017 - 04.2021
- Collaborated with development teams to identify and resolve defects efficiently.
- Communicated quality trends to management, facilitating informed decision-making.
- Compiled and tracked individual and team performance using quality monitoring system, enhancing accountability.
- Conducted internal audits to measure adherence to established QA standards.
Appeals Specialist
OrthoNet
White Plains, New York
03.2006 - 03.2017
- Managed claim reviews and appeals to uphold company policies and enhance resolution outcomes.
- Ensured compliance with regulatory guidelines to mitigate risks during appeals processes.
- Streamlined workflows to enhance efficiency in handling appeals requests.
- Compiled and analyzed data from various sources to identify trends in denials and claim issues.
Education
High School Diploma -
Adlai E. Stevenson HS
Bronx, NY06-1996
Skills
- Claims processing
- Regulatory compliance
- Provider communication
- Customer relationship management
- Appointment scheduling
- Information management
- Data analysis
Timeline
Provider Relations Specialist
OptumHealth
04.2021 - 02.2023
Quality Assurance Analyst
OptumHealth
03.2017 - 04.2021
Appeals Specialist
OrthoNet
03.2006 - 03.2017
High School Diploma -
Adlai E. Stevenson HS