Melissa D. Robinson
Credentialing Specialist
Palm Coast,FL
Summary
Seasoned and experienced Credentialing Specialist with well-rounded background in healthcare administration. Previous roles have honed skills in credential verification, exceptional organizational abilities, keen attention to detail, thorough understanding of medical staff services operations and ensuring adherence to industry standards. Known for high productivity and the ability to complete tasks swiftly. Excel in communication, problem-solving, and organization, ensuring smooth credentialing processes and effective collaboration with healthcare professionals.
Overview
14
14
years of professional experience
6
6
years of post-secondary education
Work History
Consumer Experience Specialist
AdventHealth
Ormond Beach, Florida
03.2024 - Current
- Exported, compiled, and analyzed daily performance reports from consumer-based dashboards, such Press Ganey, Five9, and Power BI detailing key metrics related to patient satisfaction.
- Provided guidance to new hires regarding onboarding processes and company culture.
- Dealt with complex concerns and developed successful resolutions satisfying business requirements and customer needs.
- Researched best practices for employee development initiatives such as mentorship programs.
- Provided frequent communication to the Consumer Experience Team on project progress, escalating any issues that could impact the budget, timeline, or strategic vision.
- Performed on-site visits with AdventHealth Medical Group practices to share, review, and provide solutions to performance related to consumer initiatives.
- Tracked communications strategies, advertising campaigns and marketing approaches to measure successes and failures.
- Aligned team objectives with organizational goals, resulting in an increased level of overall success and employee engagement.
Enrollment Specialist
Calculated Hire/CareSource
Remote, Florida
11.2023 - 03.2024
- Calculated premiums, established payment methods, handled new enrollments by entering customers' data, and reviewing information.
- Researched member eligibility and took appropriate actions to resolve issues across all eligibility systems.
- Processed mass Primary Care Physician (PCP) changes within 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.
- Remained current on latest industry trends by gaining comprehensive knowledge of financial and insurance products, services, and best practices.
- Streamlined the enrollment process for increased efficiency and enhanced user experience.
Collections Specialist I
Davita Labs
DeLand, Florida
01.2023 - 11.2023
- Point of contact to initiate collection follow-up of denials with the insurance payer to ensure proper reimbursement on claims.
- Researched submitted appeals, resolved claim rejections and underpayments, and wrote appeal letters to insurance companies for the denial of claims.
- Validated and requested insurance changes through the A/R system, as required during the collections process.
- Researched claims status, denials and appeals in order to resolve payment issues with insurance companies.
- Performed outbound calls to collect past due balances from insurance companies or other third parties.
Credentialing Coordinator
Brave Health
Remote, Florida
10.2022 - 12.2022
- Created, uploaded, and maintained provider credentialing information, utilizing programs and systems such as Symplr, CAQH, NPDB, ABMS, CMS, NPPES, DEA, and OIG.
- Collaborated with other departments as an ambassador to provide support and guidance for new providers undergoing the onboarding and credentialing process.
- Facilitated communication between departments to resolve credentialing issues efficiently.
- Followed up with licensees to verify adherence to requirements.
- Kept close tabs on documentation expiration dates, communicating with correct personnel to submit files prior to expiration.
- Investigated reported and identified compliance issues against accepted standards.
- Monitored and tracked progress of credentialing applications to ensure timely completion.
- Evaluated applications and associated documentation to determine eligibility.
- Offered high level of assistance during managed care auditing process and conducted internal file audits.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
- Performed database queries, compiling information according to requests and logging logistics changes.
- Maintained accurate files, records and credentialing documents in well-maintained databases using Symplr, CAQH, and NPDB.
- Assisted with special projects as needed, demonstrating adaptability and commitment to the success of the organization.
RPICC Data Analyst
UF Health Shands
Jacksonville, FL
11.2017 - 03.2022
- Collected, coordinated, and prepared data reports for over 300 infants monthly, including neonatal births and mortality, determining Regional Perinatal Intensive Care Centers (RPICC) eligibility and explanation.
- Collected, collaborated, and presented data on births, deaths, transfers, and transports in Labor and Delivery (L&D), NICU, and Nursery to reveal trends with stakeholders across multiple departments to develop strategies that leverage existing healthcare analytics resources.
- Collected and coordinated data retrieval with company-wide teams for special projects, including the RPICC Four-Year On-Site Review, addressing issues critical to the success of the Women’s Services department.
- Successfully achieved excellent standards for completing biannual RPICC Desk Reviews, Annual RPICC Reviews, and a four-year RPICC On-Site Review required by CMS for four consecutive years.
- Conducted regular audits of patient records to ensure accuracy of data entry.
- Maintained databases of patient histories, medications, laboratory results, insurance claims.
- Integrated disparate sources of healthcare data into a unified system for improved reporting capabilities.
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, while achieving a 99% accuracy rate.
- Conducted extensive communication with internal and external network contacts for credentialing, re-credentialing, and onboarding with physicians, and new graduate physicians.
- Successfully trained and audited approximately 15 team members for pended claims and provider enrollment claim issues during a two-year period.
- Performed verification checks for new provider enrollments in accordance with company policies and procedures.
- Reviewed and updated provider enrollment applications to ensure accuracy and completeness of information.
- Provided guidance for providers on the enrollment process, timelines, and requirements, and responded promptly to inquiries from the providers on the status of their credentialing application.
- Maintained accurate records regarding all aspects of the enrollment process in a secure database.
- Actively participated in training sessions designed to update staff on changes related to provider enrolment regulations.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Supported members through the navigation of the enrollment process to facilitate optimal decisions.
Skills
- Utilizing website such as NPPES, CMS, NCQA, NPDB, OIG, CAQH, EPIC, and Facets
- Provider enrollment
- Regulatory compliance
- Credentialing documentation
- Background checks
- Insurance procedures
- Management collaboration
- Data management
- HIPAA compliance
- Provider relations
- Proofreading
- Credential verification
- License verifications
- Employee onboarding
- Document review
- Application coordination
Teamwork and collaboration
Customer service
Problem-solving
Time management
Attention to detail
Problem-solving abilities
Multitasking Abilities
Reliability
Excellent communication
Organizational skills
Team collaboration
Active listening
Effective communication
Adaptability and flexibility
Verbal and written communication
Decision-making
Detail-oriented
Relationship building
Microsoft office
Computer proficiency
Microsoft office proficiency
Self motivation
Interpersonal skills
Analytical thinking
Goal setting
Interpersonal communication
Data collection
Quantitative and qualitative analysis
Professional demeanor
Presentation skills
Problem-solving aptitude
Fact-checking
Research methods
Data collection processes
Analytical skills
Education
Associate of Science - Medical Administrative Assistant
Baker College of Muskegon
Muskegon, MI 09.2005 - 06.2007
Bachelor of Science - Health Administration
Baker College of Muskegon
Muskegon, MI 09.2008 - 06.2010
Master of Science - Health Administration
Ohio University
Athens, OH 03.2020 - 04.2022
Work Preference
Work Type
Full TimeWork Location
On-SiteRemoteHybridImportant To Me
Work-life balanceCompany CultureFlexible work hoursPersonal development programsHealthcare benefitsWork from home optionPaid time offTeam Building / Company Retreats401k match4-day work weekCareer advancementAccomplishments
- Successfully achieved 100% passing results by coordinating and completing a 4-year annual On-Site RPICC Review with accuracy and efficiency.
- Trained and audited over 50 new employees on Provider Enrollment and Life Cycle claim issues and account maintenance.
- Trained new employees on Behavioral Standards and Expectation for new employees onboarding.
- Collaborated with team of 10 as an Ambassador in the process of onboarding new providers.
Timeline
Consumer Experience Specialist
AdventHealth
03.2024 - Current
Enrollment Specialist
Calculated Hire/CareSource
11.2023 - 03.2024
Collections Specialist I
Davita Labs
01.2023 - 11.2023
Credentialing Coordinator
Brave Health
10.2022 - 12.2022
Master of Science - Health Administration
Ohio University
03.2020 - 04.2022
RPICC Data Analyst
UF Health Shands
11.2017 - 03.2022
Provider Enrollment and Life Cycle Specialist
Priority Health
11.2010 - 09.2017
Bachelor of Science - Health Administration
Baker College of Muskegon
09.2008 - 06.2010
Associate of Science - Medical Administrative Assistant
Baker College of Muskegon
09.2005 - 06.2007
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