MELISSA LEGEE
TANGENT,OR
Summary
Current Government Programs Program Manager II with extensive knowledge of Medicare and Medicaid rules, regulations and audit requirements relating to health plans. This includes a diversified skill set and experience with coordination and implementation of projects to support Medicare and Medicaid health plan contracts and performance. The ability to tactfully delegate work including motivating others toward accomplishing goals to successfully implement efficient solutions, execution of internal processes and implementation of new programs. More than 10 years of experience in technical writing, including the development and review of policies and regulatory communications.
Overview
15
15
years of professional experience
Work History
Government Programs Program Manager II
SAMARITAN HEALTH PLANS
08.2023 - Current
- Acting as informal leader of Government Programs' team since March 2023 with direction from Director of Government Programs and Chief Operations Officer
- Leads and mentors Government Programs Program Managers
- Supervise completion of projects and daily duties to ensure compliance and contractual readiness
- Established and leads cross-functional projects for HSAG Audit Readiness
- Regularly reports project status, milestones, accomplishments, and deliverables to leadership team
- Identifies complex problems and gathers pertinent data and considers various options in decision making process
- Develops, evaluates, and implements effective solutions including delegating tasks to key parties
- Subject matter expert regarding Medicaid and Medicare Contract requirements and deliverables
- Quality reviewer for all deliverable and audit submissions to external oversight agencies such as OHA, CMS and HSAG
- Accountable for developing, implementing, and maintaining policies within Policy Tech for Government Programs department and as a member of the Policy Oversight Committee
Government Programs Program Manager
SAMARITAN HEALTH PLANS
09.2022 - 08.2023
- Acting as informal leader of Government Programs' team since March 2023 with direction from Director of Government Programs
- Completed performance evaluation for student intern for the Government Programs' department
- Provided supporting evidence, completed annual CMR audit tool documentation and participated in HSAG CMR onsite audit
- Accountable for developing, implementing, and maintaining the Performance Oversight Program for the Medicaid, Medicare Advantage, and the Dual Special Needs Plan contract
- Manages program deliverables and program strategy to ensure alignment with over-arching executive business strategy for the entire organization
- Successful leadership and implementation of Medicaid and Medicare projects to achieve goals within established timeline and budget
- Compliance oversight review and submission of all Medicare and Medicaid plan member materials
Account Management Coordinator
SAMARITAN HEALTH PLANS
01.2020 - 09.2022
- Completed leadership course, Informal Leadership: Leading from Where you Sit
- Provided supporting evidence, completed annual CMR audit tool documentation and participated in HSAG CMR onsite audit
- Collaborative approach to leading multi-department Star measure review and improvement project meetings
- Accountable for chairing the DSNP Model of Care (MOC) Taskforce including submission of the 2024 DSNP MOC resulting in a final score of 95% and a 3-year approval
- Perform reviews and analyze reports on Medicare and Medicaid contractual service requirements to ensure accurate and timely compliance
- Subject matter expert regarding Medicare, Medicaid and DSNP operational processes, benefits, policy, and contractual deliverables
- Consistently maintains knowledge of State and Federal regulations necessary to respond to inquiries accurately and constructively
- Performs Medicare and DSNP member material reviews for all departments to ensure compliance standards are met
Account Management Specialist
SAMARITAN HEALTH PLANS
09.2018 - 01.2020
- Providing supporting evidence to Coordinator for annual IHN-CCO Compliance Monitoring Review
- Responsible for answering basic questions from internal departments regarding plan benefits for the Medicare and Medicaid lines of business
- Pursued guidance on State and Federal Guidelines and escalated concerns when appropriate
- Performed research on Medicare and Medicaid benefit questions, regulations and projects as assigned in accordance with established processes
- Composed Medicare and Medicaid member and provider communications accurately and compliantly
- Performed reviews and provided reports on Medicare and Medicaid contractual requirements to Account Management team
- Acted as SHPO liaison, providing relationship management support through ongoing interdepartmental contact and with the Oregon Health Authority
Financial Specialist II
SAMARITAN HEALTH SERVICES
06.2016 - 09.2018
- Assessed and interpreted insurance benefit regulations including Medicare and Medicaid
- Adeptly managed customer inquiries regarding insurance & medical billing via phone and email
- Evaluated patients' financial status and establish appropriate payment plans
- Successfully articulated account and insurance issues with appropriate internal departments and external insurance agencies to resolve concerns in a timely fashion
Insurance Account Representative
STATE FARM
02.2015 - 05.2016
- Discovered customer needs and recommended necessary insurance services to ensure customer satisfaction and obtain sales goals
- Meticulously reviewed client accounts to ensure insurance underwriting compliance
- Responded to customer inquiries via phone and email in a prompt and courteous manner
Retail Operations Specialist
VERIZON WIRELESS
06.2011 - 07.2014
- Monitor day-to-day sales and customer service operations and performance including recommending actionable performance improvement strategies when necessary
- Assist the store manager in developing, planning, and coordinating performance improvement activities with staff
- Onboard and train new employees to ensure that they adhere to standard operating procedures
- Oversee inventory management practices and improve them when necessary
- Ensured accurate merchandising compliance and operational procedures are used by all associates to reduce loss
Customer Service Representative
VERIZON WIRELESS
06.2010 - 06.2011
- Responsible for providing friendly and timely customer service while also obtaining sales goals
- Discovering the needs of customers to successfully recommend the appropriate solutions
- Prepared for promotions by assisting in merchandising and operational needs
Education
BACHELOR OF SCIENCE - Business Administration: Marketing Management
Oregon State University
Skills
- Technical writing
- Policy development
- Research
- Federal regulations
- State regulations
- Audit readiness
- Leadership
- Coaching
- Mentoring
- Verbal communication
- Written communication
- Presentation skills
- Medicare regulations
- Medicaid regulations
Timeline
Government Programs Program Manager II
SAMARITAN HEALTH PLANS
08.2023 - Current
Government Programs Program Manager
SAMARITAN HEALTH PLANS
09.2022 - 08.2023
Account Management Coordinator
SAMARITAN HEALTH PLANS
01.2020 - 09.2022
Account Management Specialist
SAMARITAN HEALTH PLANS
09.2018 - 01.2020
Financial Specialist II
SAMARITAN HEALTH SERVICES
06.2016 - 09.2018
Insurance Account Representative
STATE FARM
02.2015 - 05.2016
Retail Operations Specialist
VERIZON WIRELESS
06.2011 - 07.2014
Customer Service Representative
VERIZON WIRELESS
06.2010 - 06.2011
BACHELOR OF SCIENCE - Business Administration: Marketing Management
Oregon State University
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