Melinda Hulon
Louisville,KY
Summary
Highly organized and self-motivated professional experienced in project management, team development and process improvement. Skilled in developing and implementing strategies to increase efficiency and performance. Passionate about driving business growth and creating positive work environment.
Overview
19
19
years of professional experience
1
1
Certification
Work History
HUMANA, INC
10.2004 - Current
- A healthcare provider offering plans, products, and services to customers to meet their healthcare needs
Associate Director, Provider Payment Integrity
Humana
12.2021 - Current
- Trained and developed department leaders and management staff for specific projects and ongoing operational needs.
- Led teams of up to 90 personnel, supervising daily performance as well as training and improvement plans.
- Assessed risks associated with team activities and implemented appropriate procedures to mitigate potential problems.
- Engaged analytical subject matter experts outside project teams to drive troubleshooting of critical process-related deviations and enhance process improvements.
- Prioritized tasks and allocated resources appropriately to keep teams focused and productive.
Provider Engagement Executive (Lead), PPI
Humana
04.2020 - 12.2021
- Build dashboards for MLT/IRT to research and analyze data more quickly for more efficient response to Providers and Markets.
- Work with Data teams for accuracy of data between systems.
- Update and maintain User Maintained Tables (UMT) owned by PPI.
- Review and keep Provider Profiles updated with accurate information and correct days codes.
- Review all special days code for aging and collection
PROVIDER ENGAGEMENT MANAGER
PROVIDER PAYMENT INTEGRITY
11.2012 - 04.2020
- Hold concurrent responsibility for acting as main point-of-contact while managing relations in as many as 20 states, driving resolutions of escalated issues, and supporting resolver teams with meeting client expectations
- Develop and implement strategic plans to identify opportunities for improvements that impact business at national level
- Collaborate with hospital system and internal teams, mitigating escalated claims issues and helping bring them to resolution
- Key Accomplishments:
- Spearheaded creation of standardized exchange process with provider for eight service centers covering more than 175 hospital groups
- Reduced current AR inventory by $8.8M and minimized claims inventory 32% by launching effective project to clean up current open inventory
- Represented Humana at state-wide hospital conferences in multiple states
- Key Contributions:
- Provide support and professional guidance for team of consultants and analysts that are focused on issue resolution for escalated, complex issues requiring root cause analysis as well as legal and settlement-related research and process navigation
- Advocate for Provider experience improvements with Provider Payment Integrity and helped improve claims processes based on direct provider feedback and engagement
- Reduce grievances and quickly resolved concerns by supporting escalated issues and collaborating with leaders across departmental units
- Provide PPI expertise to Legal and Humana Claims Policy Office
- Provide training to multiple departments within Humana of PPI processes and how to utilize the expertise provided within
- Manage key provider relationships and assisted in root cause analysis and issue resolution for escalated key issues
- Responsible for renegotiating multiple provider contracts to remove problematic verbiage which limited PPI’s ability to effectively monitor for Fraud, Waste, and Abuse
- Serve as the face of PPI to the Markets in the Region and worked to build collaborative relationships with key provider partners.
- Consulted with teams on established best practices and process improvements.
RESOLVER ANALYST
06.2009 - 11.2012
- Directly coordinated collaboration with internal partners to manage provider relationships and escalated issues
- Contributed to successful onboarding of new associates while driving to resolution of escalated issues and meeting client expectations
- Managed key provider relationships and assisted in root cause analysis and issue resolution for escalated key issues
- Provided PPI expertise to Legal and Humana Claims Policy Office
- Responsible for renegotiating multiple provider contracts to remove problematic verbiage which limited PPI’s ability to effectively monitor for Fraud, Waste, and Abuse
- Advocated for Provider experience improvements with Provider Payment Integrity and helped improve claims processes based on direct provider feedback and engagement
- Serve as the face of PPI to the Markets in the Region and worked to build collaborative relationships with key provider partners
- Onboarded new associates
SPECIAL PROJECTS SPECIALIST
PROVIDER PAYMENT INTEGRITY
05.2008 - 06.2009
- Provided direct support by reviewing and reprocessing claims as directed in each project
- Extremely high production and high quality in reprocessing of claims
- Promoted to Query writer and validator within 6 months
FINANCIAL RECOVER CUSTOMER SERVICE
03.2006 - 05.2008
- Provide issue resolution to providers in relation to overpayments
MEDICARE CUSTOMER SERVICE REPRESENTATIVE
10.2004 - 03.2006
- Provide applicable information to Member calling in
- Trained to take Provider and Pharmacy calls as bail out
Education
Bachelor of Science in Business Administration -
Troy State University of Dothan
Dothan, AL01.1993
Skills
- Executive Level Communications
- 16 years Relationship Building
- Project Management
- Quality & Compliance focus
- Staff Training & Leadership
- Organizational strategy development & implementation
- Process improvement experience across multiple departments
- Negotiation & Issue Mitigation
- Strategic Leadership
- Critical Thinking
- Analytical Thinking
- Onboarding and Training
- Public Speaking
- Decision-Making
- Team Leadership
- Change Management
- Data Analysis
- Cross-functional Collaboration
- Risk Analysis
Certification
- Certified People First Trainer, 2018
- Humana Business Acumen, 2013
- Humana Servant Leadership, 2013
Awards
Humana Star Awards - multiple
Timeline
Associate Director, Provider Payment Integrity
Humana
12.2021 - Current
Provider Engagement Executive (Lead), PPI
Humana
04.2020 - 12.2021
PROVIDER ENGAGEMENT MANAGER
PROVIDER PAYMENT INTEGRITY
11.2012 - 04.2020
RESOLVER ANALYST
06.2009 - 11.2012
SPECIAL PROJECTS SPECIALIST
PROVIDER PAYMENT INTEGRITY
05.2008 - 06.2009
FINANCIAL RECOVER CUSTOMER SERVICE
03.2006 - 05.2008
HUMANA, INC
10.2004 - Current
MEDICARE CUSTOMER SERVICE REPRESENTATIVE
10.2004 - 03.2006
Bachelor of Science in Business Administration -
Troy State University of Dothan
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