Melissa Brown
Denison,TX
Summary
Experienced professional seeking a challenging job opportunity to leverage extensive job experience and college skills. With over 20 years of medical insurance experience, brings motivation, personability, and professionalism to every task. Adheres to HIPAA compliance, with a proven track record of producing accurate and timely reports, consistently meeting goals and deadlines. Known for quick learning abilities and strong attention to detail, excels both independently and as a valuable team member.
Overview
29
29
years of professional experience
Work History
Prepay audit
CIGNA
10.2022 - Current
- Audits claims to ensure that Cigna can reach the highest potential in cost containment by applying all articles or intakes to ensure claims and savings are being implemented correctly
- I participate in meetings, have assisted in new hire classes as a SME and audited new hire claims
- I have worked in T4 and in QET and learned many edits and have handled several dedicated accounts over my span of 20 years
- I ensure that escalations/pends are handled in a timely manner
- I maintain good quality and very proficient in inpatient claims processing
- I’m always up for learning new things and have gone thru several training sessions since being on the prepay team
FVM team
CIGNA
07.2017 - 10.2022
- Handling correspondence to ensure customer quality satisfaction and avoid penalties, utilizing all resources to ensure proper departments receive images
- Also help with MSP team and questionnaires
- I also engage in weekly DSC meetings and report out to the team with results
- I attend biweekly meetings with the Biweekly FVM Call which gathers managers that are affected by FVM workflows
- I recently have attended the Transfer Opportunities Report Out meeting and gather notes to report back to the Biweekly FVM Call
- I have competed several Cigna U courses in regard to a leadership role
Dental recruiter
Kelly Services- Cigna
02.2017 - 07.2017
- Duties include contacting dental offices and offering Cigna PPO contracts
- Explaining any questions and how it can benefit the provider with our directory and potential for new patients
- Negotiating fees and processing all information needed for the provider to become contracted while updating all information for the provider and their office
Customer service rep
Broad Path Services
09.2016 - 02.2017
- Duties include answering and assisting customers with the Affordable Care Act including enrollment, eligibility, finding providers participating in area, updating patient account information, processing payments over the phone
Customer Service Rep (Medicare providers)
National Government Services
07.2013 - 06.2016
- Duties include Greeting callers appropriately and positively
- Providing accurate information for questions that Medicare providers have including claims, policies, websites, and assisting in any way possible
Office administrator
Hanger prosthetics and orthotics clinic
05.2012 - 11.2012
- Duties include Responsible for greeting customers, answering telephone, filing, generating reports, scheduling, verifying insurance, taking payments and ordering parts and supplies
Provider enrollment
Trailblazer
07.2011 - 04.2012
- Duties include Enrolling providers into the Medicare system
- Includes reviewing different applications and ensuring the correct sections are signed or filled out
- Sending letters for notification if an application is not filled out correctly
- Reaching out to providers via email and phone calls and verifying that the Medicare system has the correct information or updates
Insurance validator
West Asset
01.2010 - 07.2011
- Duties include Auditing claims which includes checking provider selection, benefits, and patient selection
- If any of this is incorrect an adjustment is made to ensure the claim is paid correctly
- Releasing the claims
- We are contracted with Cigna Healthcare's prepay team to assist in making them a more accurate and efficient work place
Claims/Correspondence processor
Cigna Healthcare
01.1996 - 01.2010
- Duties included: Paying medical insurance claims to ensure they are paid timely and correct
- Handled high dollar claims and multiple sensitive accounts for the company
- Had one year of work in the late payment interest team which was a team implemented to cut all late payment penalties
- Over a year on the correspondence team, which made adjustments to all varieties of claims
- Sent letters if needed explaining why or why not the company is paying the claim, or why it was paid this way
- Assisted with the adjustment team who as well did adjustments to claims via the call center
Emergency room registration
Wilson N Jones
06.1996 - 12.1996
- Duties included: Registering patients, including gathering insurance information and updating records
Education
College -
Grayson County College
Sherman, TX01.1995
Bible College -
Baptist Bible College
Springfield, MO01.1993
Jr College -
Weatherford Jr College
Weatherford, TX01.1992
High school -
Bowie High school
01.1991
Skills
- Claims Experience
- Customer Service
- Insurance Billing
- Follow-up
- Front Office Operations
- Medicare
- Reading Medical Contracts
- General Office Skills
- Strong communication skills
- Goal oriented approach
Timeline
Prepay audit
CIGNA
10.2022 - Current
FVM team
CIGNA
07.2017 - 10.2022
Dental recruiter
Kelly Services- Cigna
02.2017 - 07.2017
Customer service rep
Broad Path Services
09.2016 - 02.2017
Customer Service Rep (Medicare providers)
National Government Services
07.2013 - 06.2016
Office administrator
Hanger prosthetics and orthotics clinic
05.2012 - 11.2012
Provider enrollment
Trailblazer
07.2011 - 04.2012
Insurance validator
West Asset
01.2010 - 07.2011
Emergency room registration
Wilson N Jones
06.1996 - 12.1996
Claims/Correspondence processor
Cigna Healthcare
01.1996 - 01.2010
Bible College -
Baptist Bible College
Jr College -
Weatherford Jr College
High school -
Bowie High school
College -
Grayson County College
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