MELANIE P. EVANS
Alto,MO
Summary
Organized Healthcare Administrator with outstanding record of communicating with members of staff to provide administrative needs and requirements. Conducted meetings with staff concerning budgets, program management and compliance. Consistently achieved outstanding ratings for quality care and community presence.
Overview
15
15
years of professional experience
Work History
Benefits Authorizer
Social Security Administration
09.2021 - Current
- Utilize various private government systems to properly identify beneficiary data prior to issuing benefits
- Research reports of fraudulent account activity
- Investigated reports of fraudulent activity on beneficiary accounts
- Works with cross functional teams to ensure beneficiary records are accurate and complete.
- Self-motivated, with a strong sense of personal responsibility
- Proven ability to learn quickly and adapt to new situations
- Worked effectively in fast-paced environments
- Managed time efficiently in order to complete all tasks within deadlines
- Demonstrated respect, friendliness and willingness to help wherever needed
- Proved successful working within tight deadlines and a fast-paced environment
- Passionate about learning and committed to continual improvement
Director of Patient Services
Swope Health Services
02.2015 - 08.2020
- Managed 3 distinct departments ensuring successful outcomes and increased patient experience goals by 80%.
- Performed initial investigations of reported compliance concerns.
- Tracked compliance issues related internal and external business lines
- Assisted with insurance payment processing and payment issues
- Refined and developed business strategies for Patient services, Call Center and Optical Shop
- Reviewed, researched and adjudicated denied insurance claims on patient's behalf and communicated results to all stakeholders
- Identified reporting needs and created action plans to implement new reporting strategies
- Prioritized and tracked all tasks to ensure all assignments met defined KPIs.
- Implemented teams to monitor patient records and to look for suspicious and fraudulent activity regarding patient accounts
- Interpreted and implemented new or updated federal policies, laws, rules or orders to ensure compliance with regulatory bodies, receiving guidance as necessary
- Serviced extremely diverse population from all socioeconomic backgrounds.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
HR IT Contractor
Swope Health Services
06.2014 - 02.2015
- Created reports from Lawson to assist with HR operations
- Worked with Lawson analyst directly to resolve system issues
- Assisted Benefits Director with annual reporting and system updates
- Worked with IT to ensure year end patches were applied and tested
- Refined data storage process
- Researched system issues and worked with outside vendors to resolve critical issues.
- Increased HR reporting metrics by 30%.
Aviation Project Manager and Business Systems Analyst
MultiServices
08.2013 - 06.2014
- Supervised junior project managers and junior business analyst and acted as subject matter expert/
- Managed project rollouts to ensure company policy was followed, deadlines were met and stakeholders were satisfied
- Responsible for data integrity across all supported Aviation financial systems
- Liaison between Fixed Based Operators (FBOs), Customers and development team
- Analyzed data to identify root causes of problems and recommend corrective actions.
- Collaborated with stakeholders to identify business needs and data sources.
Business Systems Analyst and Help Desk Lead
NASB
09.2008 - 08.2013
- Collected, defined and analyzed business requirements.
- Trained business personnel in use of systems.
- Identified needed business improvements and determined appropriate systems required to implement solutions.
- Coordinated data migration and consolidation efforts.
- Created and maintained standard operating procedures governing system functions and features.
- Developed diagrams to describe and lay out logical operational steps.
- Enhanced interfaces to promote better functionality for users.
- Consolidated business rules for system enhancements.
- Improved systems with addition of new features and infrastructure.
Education
M.S - Management Information Systems
FRIENDS UNIVERSITY
2004
B.S - Computer Science Technology
ROCKHURST UNIVERSITY
2002
Skills
- EClinical Works
- Consumer-Related Reporting
- Research Proficiency
- Critical Thinking
- Information Gathering
- Cerner Electronic Medical Records
- Project Management
- Due Diligence
- IIBA Business Analysis
- Team Management
- Fraud Prevention
- Data Integrity
Timeline
Benefits Authorizer
Social Security Administration
09.2021 - Current
Director of Patient Services
Swope Health Services
02.2015 - 08.2020
HR IT Contractor
Swope Health Services
06.2014 - 02.2015
Aviation Project Manager and Business Systems Analyst
MultiServices
08.2013 - 06.2014
Business Systems Analyst and Help Desk Lead
NASB
09.2008 - 08.2013
M.S - Management Information Systems
FRIENDS UNIVERSITY
B.S - Computer Science Technology
ROCKHURST UNIVERSITY