Melissa Bailey
Memphis,TN
Summary
Highly educated individual with a wealth of Hedis gap closure, health prevention, education, and social service experience. Diverse background in hospital, clinic, and school settings. Consistently praised for being hard-working, resourceful, and a team-player. Skills include government administration, medical transcription, data entry, counselor, social services, and unit coordination.
Overview
13
13
years of professional experience
2
2
Certification
Work History
Central Support Operations Coordinator
Navi Health
05.2022 - Current
- Process faxes for SNF and Home Health Authorizations
- Answer incoming calls from providers to verify if authorizations have been processed, denied, or pending.
- Prepare paperwork for approval and denials.
- Create authorizations in system for new cases for Humana, UHC, and BCBS based on clinical needs.
- Answer inbound and make outbound calls for intake and provider notification of authorized days for inpatient admissions.
Hedis Service Associate II Contractor
BC Forward-Anthem Blue Cross Blue Shield
01.2022 - 04.2022
- Worked with providers office by requesting medical record information and coordinating exchange of files.
- Contacted Copy Services such as Ciox, Metacopy, ScanStat, and others to coordinate invoices for payment to expedite medical records and files.
- Explained and guided provider offices with explanation of Hedis Measures to obtain correct documents for audit.
- Answered inbound and made outbound calls for customer service call center.
Customer Service Rep
Accenture
08.2021 - 01.2022
- Answering inbound calls for State Unemployment Office
- Enter claimant Information in system to locate claim and identify approval or denial of claim.
- Make tickets and send ticket in appropriate level of claim. (Adjudication, Appeals, or State issue)
Office Operations Supervisor/ Enumerator/Hiring Admin/Payroll Processor/Interview Selector
Census 2020
08.2019 - 11.2020
- Recruited candidates for employment.
- Supervised and processed payroll for 2600 employees.
- Verified and canvassed addresses for Census ballots to be sent out for completion.
- Called and interviewed applicants for several positions
- Selected and hired applicants for Census opportunities.
- Processed weekly payroll for employees.
Tennessee Health Link Coordinator/Case Manager/Health Coach
Alliance Health Care Services
06.2018 - 01.2020
- Created person centered care plans to address clients’ physical and mental health needs.
- Counseled clients, probationers, parolees, and sex offenders with mental and medical health needs.
- Created person centered care plans for clients in Alliance Group Home Facilities for intake and admissions.
- Performed home visits for client that could not come to the center.
- Coordinated services between Primary Care and Behavioral Health providers to close HEDIS gaps.
- Provided education on chronic medical conditions such as diabetes, hypertension, and high cholesterol.
- Scheduled transportation for clients to get to appointments and return home.
- Scheduled appointments for clients with other providers for eye exams, dental appointments, diabetes and other health related test
- Provided referrals to outside agencies to facilitate social support for the client.
- Trained new Coordinators with policies and duties related to position.
- Coordinator care for Alliance patients in group home settings.
- Coordinated monthly HIV/AIDS Education Group Classes.
- Coordinated education on pregnancy, abstinence, childbirth, transgender, the effects of drugs and alcohol on fetus, std prevention and birth control.
- Assisted clients with discharge orders once they are discharged from hospital to get back in compliance with treatment plans.
- Assisted clients with getting their high school diplomas.
Lead Medical Records and Intake Clerk
State of Ohio Department of Health Bureau of Children with Medical Handicaps
12.2012 - 11.2016
- Lead Medical Records and Intake Clerk; supervised 4 other records employees.
- Counseled and interviewed clients to determine needs, benefits, and eligibility for assistance.
- Processed applications and intake forms for families with medical needs for assistance with medical bills, prescriptions, and medical equipment.
- Verified Medicaid and health insurance for benefits. Enter information for claims processing. Process medical records for electronic entering.
- Worked with parents in the schools, community centers and local health department to assist with community building, medical needs, and educational assistance.
Education
Ph.D. - Theology
Missionary Chapel And Seminary
Murfreesboro, TN06-2024
Master of Education - undefined
Grand Canyon University
01.2017
Master of Public Administration - undefined
Grand Canyon University
01.2015
Skills
- Scheduling management
- Customer invoicing
- Process implementation
- Supply ordering
- Administrative management
- Payroll administration
- Conflict mediation
- Quality assurance oversight
- Quality assurance and control
- Scheduling coordination
- Quality assurance
- Management
- Customer relationship management
- Staff supervision
- Delegation
- Human resources
- Productivity management
- Teamwork and collaboration
- Customer service
- Decision-making
- Goal setting
- Student engagement
- Behavior management
- Classroom instruction
- Group and individual instruction
- Cooperative learning experience
- HEDIS knowledge
- HIPAA
- Patient care coordination
- Healthcare management
- Patient advocacy
- Care planning
- Insurance practices
- Data entry
- Crisis intervention
- Discharge planning
- At-home care instruction
- Electronic medical record software
- Certified in CPR/AED
- Epic systems
Certification
- OutMemphis: I Know – HIV Testing and Counseling Training
- CPI Certified
- Orasure Oraquick HCV Finger Prick Certified
- Tuberculosis Control Guidelines and Screening Certified
- OraQuick Rapid Antibody HIV Test, Tn. HIV Prevention Counseling and Testing.
- CPR Certified
- Certified Financial Educator
- CDC in HIV Rapid Screening
- New York Department of Health- HIV and AIDS Certificate
Timeline
Central Support Operations Coordinator
Navi Health
05.2022 - Current
Hedis Service Associate II Contractor
BC Forward-Anthem Blue Cross Blue Shield
01.2022 - 04.2022
Customer Service Rep
Accenture
08.2021 - 01.2022
Office Operations Supervisor/ Enumerator/Hiring Admin/Payroll Processor/Interview Selector
Census 2020
08.2019 - 11.2020
Tennessee Health Link Coordinator/Case Manager/Health Coach
Alliance Health Care Services
06.2018 - 01.2020
Lead Medical Records and Intake Clerk
State of Ohio Department of Health Bureau of Children with Medical Handicaps
12.2012 - 11.2016
Master of Education - undefined
Grand Canyon University
Master of Public Administration - undefined
Grand Canyon University
Ph.D. - Theology
Missionary Chapel And Seminary
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