Melissa Greene
Ridgeland,SC
Summary
Systematic Clinical Specialist successful at collaborating with customers, support teams, and healthcare clinicians to effectively implement and support products. Experienced in solving problems and facilitating communications by using a flexible and personal style. Ready to bring many years of experience to a long-term role with growth potential.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Physican General Clinical Specialist
Evicore
Ridgeland, SC
10.2006 - Current
- Conducted clinical reviews of medical records to ensure compliance with regulatory requirements.
- Analyzed patient information and data to identify any discrepancies or errors in the documentation.
- Participated in interdisciplinary meetings to discuss complex cases and recommend appropriate action plans.
- Provided feedback to providers on coding accuracy and quality improvement initiatives.
- Collaborated with other departments to coordinate care for patients requiring additional services.
- Assisted with developing policies and procedures related to clinical review processes.
- Reviewed appeals from providers regarding denied claims and provided recommendations for resolution.
- Maintained current knowledge of applicable laws, regulations, standards, guidelines, and best practices related to clinical review activities.
- Evaluated provider performance against established criteria for quality assurance purposes.
- Adhered to all HIPAA regulations when handling confidential patient information.
- Identified areas of risk and developed strategies for mitigating them.
- Reviewed utilization management decisions made by payers or other entities.
- Performed audits of medical records according to established protocols.
- Compiled reports summarizing findings from case reviews.
- Interpreted medical literature relevant to the clinical review process.
- Developed educational materials on topics related to clinical reviews.
- Facilitated communication between providers and payers regarding denials or issues identified during the review process.
- Worked closely with physicians, nurses, pharmacists, social workers, and other healthcare professionals as needed.
- Provided training sessions on proper documentation techniques and coding accuracy for staff members.
- Maintained positive working relationship with fellow staff and management.
- Handled incoming calls and directed callers to appropriate department or employee.
- Answered questions and fulfilled requests with friendly and knowledgeable service.
- Entered patient insurance, demographic and health information into software and confirmed records.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Streamlined day-to-day office processes to meet long-term goals.
- Determined and implemented techniques to improve medical records retrieval process.
- Mentored junior team members and managed employee relationships.
Radiologic Technologist/Back Office Medical Assistant
Hilton Head Hospital Tenet Healthcare
Hilton Head Island, SC
11.1995 - 11.2003
- Performed radiologic examinations utilizing computed tomography, magnetic resonance imaging, ultrasound and other specialized equipment.
- Conducted quality control tests on all radiologic equipment to ensure accuracy of images produced.
- Provided patient care instructions prior to radiologic procedures and administered contrast agents as needed.
- Maintained a safe environment by adhering to radiation safety protocols and guidelines.
- Assisted physicians in performing interventional radiology procedures including biopsies, catheter placements and drainages.
- Reviewed medical histories and prepared patients for exams by positioning them appropriately on the exam table.
- Collaborated with multidisciplinary team members such as nurses and physicians to provide excellent patient care services.
- Developed films manually or via automated processing systems according to departmental standards.
- Monitored patient's condition during radiologic procedures in order to maintain comfort level throughout the process.
- Documented examination results accurately in patient records for future reference by healthcare providers.
- Interpreted diagnostic imaging studies such as CT scans, MRIs, X-rays for diagnosis of diseases or injuries.
- Prepared sterile trays containing instruments necessary for special procedures like arthrograms.
- Operated portable x-ray machines in order to capture images of patients at bedside or other locations inside the hospital premises.
- Ensured that all documents related to patients' medical history were maintained properly according to HIPAA regulations.
Radiologic Technologist
Hinsdale Hospital
Hinsdale, IL
12.1992 - 11.1995
- Conducted quality control tests on all radiologic equipment to ensure accuracy of images produced.
- Provided patient care instructions prior to radiologic procedures and administered contrast agents as needed.
- Maintained a safe environment by adhering to radiation safety protocols and guidelines.
- Assisted physicians in performing interventional radiology procedures including biopsies, catheter placements and drainages.
- Collaborated with multidisciplinary team members such as nurses and physicians to provide excellent patient care services.
- Developed films manually or via automated processing systems according to departmental standards.
- Interpreted diagnostic imaging studies such as CT scans, MRIs, X-rays for diagnosis of diseases or injuries.
- Educated patients about radiological procedure risks, benefits and alternatives as well as post-exam restrictions or instructions.
- Prepared sterile trays containing instruments necessary for special procedures like arthrograms.
- Operated portable x-ray machines in order to capture images of patients at bedside or other locations inside the hospital premises.
- Operated mobile imaging equipment to capture medical information at patients' bedsides, operating, and emergency rooms.
- Positioned patients and x-ray and CT equipment, and implemented beam-restrictive devices and shielding techniques to minimize radiation exposure.
- Oversaw scheduling, patient coordination and department and equipment maintenance for consistent department operations.
Education
Certification Program With ARRT Licensing - Radiology
Hinsdale Hospital School of Radiography
Hinsdale, IL09-1992
Skills
- New hire Nursing Trainer for Image One and CDP/UPADS
- proficient in Microsoft products
- Examining denial rationale
- working closely with physicians on case processing issues
- Building and developing educational materials
- Building SharePoint sites
- Team building and support
- Utilization management
- 18 years of experience with eviCore
- Monitoring multiple chats for multiple specialties
- Collaborates with the Clinical Content team to stay abreast of policy and guideline changes that impact clinical output
- Competent use of smart sheets for data tracking
- Competent in training, clinical certification, utilization management, URAC, and NCQA principles, policies, and procedures
Certification
- ARRT Certification
Accomplishments
- 150 Cigna Standout receiver
Affiliations
- Leadership roles in my personal life include owning two successful owner operated business for over 6 years.
- I have developed strong leadership skills within my hobby club of foxhunting which requires strong teamwork and communication skills all while maintaining a safe and fun experience for members and guests. This is a very high profile sport and being a nominated leader is an honor and privilege.
Timeline
Physican General Clinical Specialist
Evicore
10.2006 - Current
Radiologic Technologist/Back Office Medical Assistant
Hilton Head Hospital Tenet Healthcare
11.1995 - 11.2003
Radiologic Technologist
Hinsdale Hospital
12.1992 - 11.1995
- ARRT Certification
Certification Program With ARRT Licensing - Radiology
Hinsdale Hospital School of Radiography
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