Melissa A. Seifert
Morgantown
Summary
Skilled writing professional with focus on delivering impactful content. Adept at team collaboration, ensuring reliable and flexible support in dynamic environments. Proficient in crafting compelling narratives, conducting thorough research, and maintaining high standards of accuracy and clarity. Known for strong communication skills and results-driven approach.
Overview
29
29
years of professional experience
Work History
Associate Director of Appeals Optimization
Optum Executive Health Resources
10.2022 - Current
- Continued responsibilities as the Appeals Operation Product Lead with added focus on new products and increasing client awareness of appeals root causes and opportunities for appeal
Appeals Operations Product Lead, Manager
Optum Executive Health Resources
01.2017 - Current
- Operate as the Appeals Department Liaison for all new appeal products and client special requests
- Took the lead role in the requirement process coordinating the needs for a new appeals platform for the company
- Participate in the Application Development process for upgrades to current computer applications for Appeals as well
- Work on special project requests as required including analyzing payer behaviors/trends and compiling data to support findings
- Streamlined and changed appeals letter writing process to make the team more efficient resulting in higher overturn rates as well as cost savings for the company
- Collaborate with all areas of the business including Regulatory, Contracts, Nurse and Physician leaders, and upper management to ensure business needs are met in the Appeals department
- Partnered with client-facing staff to determine client needs and if feasible to pursue in the Appeals department
- Re-defined business platform to allow for more efficient processing and data capturing for our appeals clients
Appeals Nurse Manager
Optum Executive Health Resources
07.2013 - 12.2016
- Managed and lead 6 direct reports with approximately 60 front-line RNs under them collectively
- Developed and maintained new processes for the front-line RNs as business needs evolved
- Participated on leadership committees to help determine areas of expansion for the appeals department
- Developed plans to improve Employee Engagement scores on Vital Signs survey
- Worked closely with Supervisors and Director of Appeals on employee related issues
- Provided cross-team training to nurses in other departments to meet business needs
- Collaborated to develop a Quality Assessment tool to allow for more consistent approach to quality reviews
Government Appeals Nurse Supervisor
Executive Health Resources
07.2012 - 07.2013
- Successfully lead a team of 10-13 nurses with consistent quality and productivity levels to meet company standards
- Quickly identified employees with any quality or productivity issues and mentored them to avoid further disciplinary actions
- Participated in new nurse screening and hiring process including the overseas nurses in Manila
- Assisted in training large groups of new nurses to the Appeals Department during orientation
- Mentored, with 1:1 supervision, several new nurses into quality Appeals Nurse letter writers
- Assisted in the training of new supervisors providing continued support and guidance in their role as a supervisor
- Developed the guidelines on how to handle client calls and trained new supervisors in handling client calls
- Provided guidance to NLC supervisor to develop parallel Quality Guidelines and establish the steps required before placing someone on a CAP
- Project leader for a pilot program in Commercial Appeals including developing the nursing process for searching, processing and writing letters for a case. Additionally, have identified areas of improvement for the entire Commercial Department
- Assisted in the development of the Medicaid pilot project process providing input on training ideas and a comprehensive process
Appeals Nurse
Executive Health Resources
03.2012 - 07.2012
- Authored quality letters for Government appeals cases. Mastered the appeals software and the argument books.
- Assigned to a special project to write letters at the Pre-ALJ level requiring a more detailed and clinically based letter.
Assistant Director of Nursing
HCR Manor Care
09.2010 - 02.2012
- Managed two long-term care floors. Responsible for 70 residents and 24 staff members.
- Oversaw day-to-day operations of the floors.
- Participated in staffing decisions to ensure safe care to all residents
- Interacted on a regular basis with physicians to ensure proper care of residents daily as well as with acute changes in resident status
- Advocated for residents and their families to ensure all needs were met
- Keep up to date on State regulations to ensure compliance in residents’ care
- Provided education to all staff to ensure regulatory compliance as well as improve clinical outcomes of residents
Telemetry RN
Progressive Care Unit – Pottstown Memorial Medical Center
09.2007 - 09.2010
Director of Nursing
Surgical Institute of Reading
11.2006 - 07.2007
Nurse Recruiter/Staff Nurse
Pottstown Memorial Medical Center
07.2004 - 11.2006
Home Health Nurse
Patient Care
04.2006 - 07.2006
Operating Room Nurse, Certified
Reading Hospital & Medical Center
10.1998 - 04.2006
Emergency Room Nurse
Reading Hospital & Medical Center
06.1996 - 10.1998
Education
Bachelor of Science - Nursing
Capella University
06.2019
Associates in Applied Science - Nursing
Reading Area Community College
Skills
- Strategic leadership
- Operations management
- Critical thinking
- Onboarding and training (US and Philippines)
- MS office
- Hiring and training
- Analytical thinking
- Coaching and mentoring
- Relationship building
- Team collaboration and leadership
- Process improvement
Awards
2021 & 2022 – Nominated for Sages Clinical Award, 2020 – Nominated as an Optum Super Hero, Achieved Manager Effectiveness Index of 95% three consecutive years, 2013, 2014, and 2015, 2013 – Received Star Achiever Award
Timeline
Associate Director of Appeals Optimization
Optum Executive Health Resources
10.2022 - Current
Appeals Operations Product Lead, Manager
Optum Executive Health Resources
01.2017 - Current
Appeals Nurse Manager
Optum Executive Health Resources
07.2013 - 12.2016
Government Appeals Nurse Supervisor
Executive Health Resources
07.2012 - 07.2013
Appeals Nurse
Executive Health Resources
03.2012 - 07.2012
Assistant Director of Nursing
HCR Manor Care
09.2010 - 02.2012
Telemetry RN
Progressive Care Unit – Pottstown Memorial Medical Center
09.2007 - 09.2010
Director of Nursing
Surgical Institute of Reading
11.2006 - 07.2007
Home Health Nurse
Patient Care
04.2006 - 07.2006
Nurse Recruiter/Staff Nurse
Pottstown Memorial Medical Center
07.2004 - 11.2006
Operating Room Nurse, Certified
Reading Hospital & Medical Center
10.1998 - 04.2006
Emergency Room Nurse
Reading Hospital & Medical Center
06.1996 - 10.1998
Associates in Applied Science - Nursing
Reading Area Community College
Bachelor of Science - Nursing
Capella University
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