Melissa D. Robinson
Palm Coast,USA
Summary
Knowledgeable and seasoned Credentialing Specialist with well-rounded background and expertise in the areas of provider enrollment, credentialing, accreditation compliance, claims research and processing, . Previous roles have honed skills in credential verification, database management, adept at verifying primary sources and access-level tiers,and regulatory compliance. Strengths include exceptional organizational abilities, keen attention to detail, and thorough understanding of medical staff services operations. Known for high productivity and the ability to complete tasks swiftly, while ensuring adherence to industry standards.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Consumer Experience Specialist
AdventHealth
Ormond Beach, Florida
03.2024 - Current
- Preparing and creating learning materials using various mediums and teaching methods
- Export and analyzing daily performance reports from consumer-based dashboards, such as Five9 and PowerBI Phone Dashboard to related key consumer promises and initiatives
- Identify new capabilities, improvements, and/or enhancements to proactively partner and collaborate with identified medical practices
- Provide frequent communication to the Consumer Experience Team on project progress, escalating any issues that could impact the budget, timeline, or strategic vision
- Perform On-site visits with AdventHealth Medical Group practices to share, review, and provide solutions to performance related to consumers initiatives
Enrollment Specialist
Calculated Hire/CareSource
Remote, Florida
10.2023 - 03.2024
- Completion of daily change file pre-processor exceptions and monthly full file pre-processor exceptions
- Researched member eligibility and take appropriate actions to resolve issues across all eligibility systems
- Processed mass Primary Care Physician (PCP) changes with Provider Operations
- Researched, reviewed, and interpreted eligibility data to respond to eligibility inquiries from contracted vendors
- Accessed state and federal government systems to review and confirm eligibility status
Collections Specialist I
Davita Labs
DeLand, Florida
01.2023 - 11.2023
- Point of contact to Initiate collection follow-up of denials with insurance payer to ensure proper reimbursement on claims
- Researched appeals and resolved claim rejections and underpayments with the payer based on payer terms
- Validated and requested insurance changes through the A/R system as required during collections process
- Retrieved assigned data and prioritizes based on AR department guidelines
Credentialing Coordinator
Brave Health
Remote, Florida
10.2022 - 12.2022
- Served as point of contact for new providers by collaborating, assisting, and updating providers on the credentialing process
- Created, uploaded, and maintained provider credentialing information utilizing programs and systems such as Symplr, CAQH, NPDB, ABMS, CMS, NPPES, Availty, DEA, and OIG
- Collaborated with other departments to serve as an ambassador for new providers undergoing the onboarding process
- Expedited completion of credentialing projects
RPICC Data Analyst
UF Health Shands
Jacksonville, FL
11.2017 - 03.2022
- Collected, coordinated and prepared data reports for 300+ infants monthly, including neonatal births and mortality, determining Regional Perinatal Intensive Care Centers (RPICC) eligibility and explanation
- Collected and presented data on births, deaths, transfers, and transports in Labor and Delivery (L&D), NICU and Nursery to reveal trends on a bi-monthly basis
- Collected and coordinated data retrieval with company-wide teams for special projects including RPICC Four-Year On-Site Review addressing issues critical to success of the Women’s Services department
- Coordinated and achieved excellent standards for completing bi-annual RPICC Desk Reviews, Annual RPICC Reviews, and a four-year RPICC On-Site Review required by CMS for four consecutive years
Provider Enrollment and Life Cycle Specialist
Priority Health
Grand Rapids, MI
11.2010 - 09.2017
- Researched, resolved, and achieved the daily goal minimum of 60 provider claim issues per day using Facets, while achieving a 99% accuracy rate
- Researched, collected, and followed-up on provider’s background, licenses, employment, and education data for provider accreditation, credentialing, and re-credentialing utilizing CAQH, NPDB, ABMS, OIG, DEA, CMs, and NPPES
- Conducted extensive communication with internal and external network contacts for credentialing, re-credentialing, and onboarding with physicians and new graduate physicians
- Supported Contract Department with contracting efforts, maintained up to date profiles, uploaded documents in PDF formats and performed re-attestation on provider profiles every 120 days
- Trained/audited approximately 15+ team members for pended claims and provider enrollment claim issues during two-year period
Education
Master of Health Administration -
Ohio University
Athens, OH01.2022
Skills
- CAQH Proview
- Facets
- EPIC
- OnBase
- MedMetrix
- NPPES
- CMS
- NPDB
- HHS-OIG
- AMA
- ABMS
- Availty
- Employee onboarding
- Credential verification
- Credentialing documentation
- Regulatory compliance
- License verifications
- Provider relations
- Document review
- HIPAA compliance
- Database maintenance
- Report generation
- Application coordination
- Provider enrollment
- Management collaboration
- Data management
- Proofreading
- Solo practitioner credentialing
- Accreditation information management
- Credentialing oversight
- Insurance procedures
- Background checks
Certification
- CITI Program: Social and Behavioral Investigators and Key Personnel Modules, 01/21
- Institute for Healthcare Improvement: Certified Professionals in Healthcare Quality, 01/21
References
References available upon request.
Timeline
Consumer Experience Specialist
AdventHealth
03.2024 - Current
Enrollment Specialist
Calculated Hire/CareSource
10.2023 - 03.2024
Collections Specialist I
Davita Labs
01.2023 - 11.2023
Credentialing Coordinator
Brave Health
10.2022 - 12.2022
RPICC Data Analyst
UF Health Shands
11.2017 - 03.2022
Provider Enrollment and Life Cycle Specialist
Priority Health
11.2010 - 09.2017
Master of Health Administration -
Ohio University