Summary
Skills
Work History
Education
Accomplishments
Overview
Generic

MELISSA CRABB

Revenue Management
Lewisville,TX

Summary

Experienced healthcare revenue cycle professional with strong leadership and relationship-building skills. Dedicated to enhancing operations with an analytical and disciplined approach. Able to work with minimal direction to solve problems, resolve conflicts and respond to customer inquiries.

Skills

Payer Methodologies

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Work History

Revenue Integrity Recovery Coordinator

Trinity Health St Peter's Health Partners
Remote , NY
11.2021 - Current
  • Collaborated with team members to achieve target results.
  • Conducted research, gathered information from multiple sources, and presented results.
  • Led projects and analyzed data to identify opportunities for improvement.
  • Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
  • Created plans and communicated deadlines to complete projects on time.
  • Used critical thinking to break down problems, evaluate solutions and decide.
  • Drove operational improvements which resulted in savings and improved profit margins

Revenue Integrity Reporting Analyst

Steward Healthcare
Richardson , TX
08.2019 - 11.2021
  • Operationalized access to payer communications within Revenue Integrity (RI) department
  • Interpreted Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection
  • Prepared weekly summary document of payer notifications to distribute to Steward Health Care Hospitals and Corporate groups that identified the change information
  • Created and maintains “library” of payer notifications
  • Used Craneware Charge Master Toolkit and Meditech Patient Accounting to aid in pulling usage reports for an analyst review
  • Ran SQL based reports for auditing purposes relating to charge codes and usages
  • Investigated possible coding and / or compliance concerns related to charging
  • Assisted Revenue Integrity CDM analyst with reporting function and creation of reports

Neurology Clinical Denial Analyst, III

MSRDP, UT Southwestern Medical Center
Dallas , TX
12.2017 - 08.2019
  • Contacts payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more
  • Interprets Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection
  • Identifies denial trends and researches to resolve the trending issues
  • Verifies data integrity and accuracy
  • Enters details such as payments, account information and call logs into the computer system
  • Responds to department requests via email regarding denials and questions on accounts.

Epic Charge Analyst

Children's Health
Dallas , TX
07.2016 - 11.2017
  • Created Charge Reconciliation reports for clinical charge capture
  • Analyzed charge denials for payer trends
  • Researched and interpreted billing and coding changes to determine impact
  • Conducted compliance audits to determine accuracy of the facility’s billing and coding methods
  • Created and tested Epic Claim edits in compliance with CMS rules
  • Reviewed weekly reports and performed administrative changes to accounts.

Associate Process Manager

Conifer Health Solutions
Frisco , TX
01.2015 - 04.2016
  • Supported external clients (all Tenet) related to process related enhancements
  • Worked with operations, Process Engineers and other key business units to drive process improvement
  • Designed,Designed, build and tracked any changes to the Process Maps and policy/procedures
  • Created quality reports with emphasis are key metrics
  • Performed initial client assessment and analysis to begin the research process
  • Managed quality reporting of key metrics for all Tenet Hospitals
  • Trained front end users with newly implemented software, including development and oversight.
  • Gathered and analyzed large amounts of data to determine improvement projections.

Lead Denial Analyst

Conifer Healthcare Solutions
Frisco , TX
03.2012 - 01.2015
  • Validated denial reasons and, if necessary, generates appeal based on dispute reason and contract terms
  • Reviewed authorization denials and determines whether appeal requires a clinical review or can be handled from a technical perspective
  • Researched contract terms/interpretation and compiles necessary supporting documentation for appeals, Terms & Conditions for Internet based contract system
  • Performed research and corrective actions for the following: Incorrect patient type, facility audit, incorrect adjust adjudication, non-covered services, requests nurse audits, updates payer code
  • Extensive knowledge of Managed Medicaid and Managed Medicare payers
  • Created and distributed job aids with current payer information and updates.

Education

Associate of Applied Science - Business Leadership Development

Northeast Wisconsin Technical College
Green Bay, WI
01.2018 - Current

Technical Diploma - Medical Coding

Northeast Wisconsin Technical College
Green Bay, WI
01.2018 - Current

Technical Diploma - Healthcare Business Professional

Northeast Wisconsin Technical College
Green Bay, WI
01.2018 - Current

Bachelor of Science - Criminal Justice, Emergency Management

University of North Texas
Denton, TX
08.2009 - 08.2010

Associate of Applied Science - Criminal Justice - Law Enforcement

Northeast Wisconsin Technical College
Green Bay, WI
08.2005 - 08.2011

Accomplishments

  • Epic Charge Router – Proficient
  • Medical Coding (inpatient/outpatient) – IN PROGRESS
  • Ethical Leadership – IN PROGRESS
  • Advanced Health Care Leadership – IN PROGRESS
  • Health Care Leadership – Complete 2021
  • Supervision Pathway – IN PROGRESS
  • Supervisory Management – IN PROGRESS
  • Project Management – IN PROGRESS

Overview

10
10
years of professional experience
21
21
years of post-secondary education

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MELISSA CRABBRevenue Management