Summary
Overview
Work History
Skills
Timeline
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Melissa Burke

Denton,TX

Summary

Experienced Advanced Registered Medical Assistant with a 19-year track record leading teams and supervising operations at UnitedHealth Group. Seeking to leverage skills and expertise to contribute to organizational growth and further develop professional career. Committed to advancing knowledge and skills by aligning with an organization that shares core values and offers opportunities for personal and professional growth.

Overview

22
22
years of professional experience

Work History

Call Center Clinical Help Desk Care Coordinator Housecalls/Previsit Navigator Housecalls

UnitedHealthGroup
03.2022 - Current
  • Effectively resolve concerns, problems, questions, and complaints for members, providers and advanced practice clinicians, triaging to the appropriate team when necessary
  • Serve as bridge between healthcare practitioners and members to answer questions and address concerns related to member care.
  • Obtain and send medical records when requested by a provider per hipaa policies and regulations
  • Call members and/or providers with laboratory and/or test results
  • Perform data entry and complete accurate documentation of calls in electronic medical records system
  • Entering and submitting internal referrals to social work and nurse care managers
  • Executed completion of communication tasks promptly
  • Cooperated with supervisor in recognizing areas for system improvements, resulting in greater operational efficiency.
  • Applied in-depth knowledge of HIPAA standards effectively.
  • Maintained a track record of exceeding quality criteria for calls and performance goals.
  • Intermediate proficiency of Microsoft products (word/office/teams/excel/PowerPoint), IEX, Enterprise Now, SharePoint and EMR systems
  • Leader in team of 14, with responsibilities including coverage and scheduling of team, training and retraining of team, being a support and providing solutions for problems and concerns.
  • Exhibits exceptional communication abilities, efficient time management, and strong organizational skills on a daily basis.
  • Facilitator for Your Voice Matters Survey and teams to help teams find solutions for concerns
  • Demonstrated strong attention to detail.
  • Demonstrated expertise in medical terminology.
  • Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations.
  • Assessed patient needs and connected them with appropriate resources to ensure optimal health outcomes.

Clinical Practice Quality Coordinator/Clinical Supervisor/Medical Assistant

USMD-UnitedHealth Group
10.2005 - 03.2022
  • Supervised clinical team of 10 in a high-pressure primary care environment.
  • Displayed efficient daily organization, adept problem resolution, and proficient project oversight.
  • More than ten years managing HEDIS and CMS Star rating processes.
  • Oversaw diverse, intricate projects including risk management and quality initiatives.
  • Oversaw staffing arrangements.
  • Organized and facilitated regular team meetings involving various organizational levels.
  • Instructed and trained all new staff; educated staff on new policies and procedures; performed annual skills and check offs on all staff on several skills.
  • Possessed in-depth understanding of HEDIS/STARS/CMS.
  • Analyze data, evaluate for data deficits, document and report findings/data mining, process improvement
  • Recognize obstacles to enhancements and HEDIS/STARS implementation.
  • Collaborated with senior leadership, office management, providers, and clinical teams to develop strategies addressing quality gaps.
  • Partner with upper management, office manager, providers and clinical staff to identify trends observed and potential strategies to support practice
  • Track barriers/challenges so that better outcomes could be achieved including access to appointments, lack of follow up on referrals, or inconsistent billing practices.
  • Advanced knowledge and experience with coding and billing (ICD10 and CPT codes), scribing and transcription, claims, insurance authorizations, prior authorizations and precertification experience.
  • Monitored compliance with organizational policies and protocols.
  • Conducted training on adherence to PHSA/JCAHO requirements.
  • Recognized obstacles in clinical processes, introducing innovative solutions to optimize operational efficiency.
  • Coordinated cross-functional teams for successful project completion.
  • Collaborated with team to improve patient experiences (press ganey), along with leadership to excel in quality measures
  • Experienced with Microsoft applications (word/excel/PowerPoint/teams/outlook), multiple EMR systems, multiple Data entry systems
  • Advanced knowledge of medical terminology
  • Advanced experience in managed care and matrix environment
  • Advance knowledge of CAHPS, NCQA, CMS requirements

Personal Banker

Woodforest National Bank
09.2003 - 10.2005
  • Utilized strong interpersonal communication skills during client interactions, resulting in increased trust and fostering long-lasting relationships.
  • Assisted customers with setting up or closing accounts, completing loan applications, and signing up for new services.
  • Maintained compliance with bank policies and regulations while executing various financial transactions for customers.
  • Generated new business by conducting thorough financial needs assessments and offering tailored products to clients.
  • Improved customer satisfaction by providing personalized banking solutions and exceptional service.
  • Managed deposits, withdrawals and wire transfers to process smooth banking transactions for clients.
  • Promoted financial products by maintaining excellent service offering knowledge.
  • Cross-sold bank products and services to meet customer needs and provide options.
  • Processed customer requests for statements, ordering additional checks, and updating customer personal information in database.
  • Contributed to a positive work environment, fostering teamwork among colleagues to enhance productivity levels.

Skills

  • Organizational skills
  • Healthcare operations
  • Nursing background
  • Quality assurance
  • Process improvements
  • Problem-solving
  • Time management
  • Multitasking and organization
  • Clear communication
  • Team collaboration
  • Verbal and written communication
  • Data entry
  • Clinical quality program standards
  • Documentation

Timeline

Call Center Clinical Help Desk Care Coordinator Housecalls/Previsit Navigator Housecalls

UnitedHealthGroup
03.2022 - Current

Clinical Practice Quality Coordinator/Clinical Supervisor/Medical Assistant

USMD-UnitedHealth Group
10.2005 - 03.2022

Personal Banker

Woodforest National Bank
09.2003 - 10.2005

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Melissa Burke