MELISSA L. HODGSON
Milwaukee,Wisconsin
Summary
To obtain a challenging position which will allow me to demonstrate my abilities, and utilize my comprehensive knowledge, experience, analytical and interpersonal skills; a position that provides the potential for professional growth and advancement.
Medical support professional with strong background in patient care, clinical procedures, and administrative tasks. Highly skilled in phlebotomy, patient communication, and electronic health records management. Known for effective collaboration, reliability, and adaptability in fast-paced environments. Focused on delivering exceptional patient outcomes and supporting healthcare teams in achieving operational goals.
Overview
26
26
years of professional experience
Work History
Advanced Medical Assistant Specialist
Vattern Affairs Clement Zablocki Medical Center
12.2023 - Current
- Processing no shows, and cancellations
- Call patients to coordinate and schedule medical appointments.
- Provide resources to patients, behavioral health, and other wellbeing needs.
- Admitting, canceling, checking out patient appointments in the ISS system.
- Reviewing CPRS charting notes to confirm patient’s medical orders are completed, and status of care based on doctors notes.
- Directing patients to next appointment, and other locations within VA Clement Zablocki Medical Center.
- Updating Teams Chat with detail information to help with flow of the Clinics.
- Working closely with Management to help identify issues, for insight to help provide a better workflow for Lab Draw Dept.
- I’m skilled in using these systems: Cisco ACD line, Word, Excel, CPRS, VISTA, ICB, Teams Chat, and Microsoft Outlook.
Appeals and Grievances Specialist Marketplace (remote position)
Molina Healthcare
09.2021 - 12.2023
- Processing general and expedited appeals from providers.
- Processing verbal and written appeal and grievances received from members, and providers.
- Responsibilities within the Marketplace, Medicaid for Illinois, Michigan and Wisconsin.
- Reviewing claims received from various providers (billing errors).
- Calling Providers concerning billing errors.
- Working and processing member’s grievances written, and verbal based on NCQA guidelines.
- Coordinate peer to peer meeting with the Appeal Committee Physicians and outside medical providers.
- Working Qnxt closed cases- Educating Agents on errors made and information not provided to the members.
- Routing appeal, grievances to various teams within Molina Healthcare, for a resolution of various issues.
- Provided members with resolution for written, and verbal grievances within state contracted guidelines.
CUSTOMER SERVICE REPRESENTATIVE
CHIROTOUCH
06.2019 - 03.2020
- Responsibilities within this nationwide third-party billing company for chiropractors included answering calls and resolving discrepancies.
- Performed detailed research to resolve problems and issues; served as a liaison between accounts receivable representatives, clinic managers, patients, and cash posting representatives.
- Produced patient statements for doctors throughout the State.
- Developed proficiency in Excel to generate patient statements; submitted to clinics for review and authorization to bill.
FOLLOW-UP REPRESENTATIVE II (hybrid position)
AURORA HEALTH CARE
09.2004 - 06.2019
- Accounts Receivables following-up Workers’ Compensation hospital billing for all hospitals, for facility charges.
- Rolled CPT billing codes (Billing)
- Submitted bills and records electronically to the insurance companies, via the Jopari web site.
- Reviewed Explanation of Benefits for payments received, and sent reconsiderations for additional payments, if not paid correctly.
- Also reviewed accounts to confirm they were paid by contract rate, or fee schedule. Worked closely with Adjusters, and Claims Review Reps to resolve claims issues. When appropriate, closed-out files.
- As necessary, escalated reconsiderations to the State of Wisconsin for Appeals.
- Trained new employees to the department; wrote policy and procedures.
- This position evolved to a hybrid position in 2018 (3days home, 2days in the office) Promoted to Follow-Up Representative II. In 2014.
INSURANCE ASSISTANT
INSURANCE ASSISTANT
01.2001 - 09.2004
- In addition to the duties of Registration Clerk in the Perinatal Assessment Center at Aurora Sinai Samaritan Medical Center, responsible for department Front Desk Clerk.
- Responsible for answering telephones, obtaining pre-authorizations, checking patients in and out, pulling charts, admitting patients to the hospital as inpatient, as well as transporting to inpatient assignments.
PATIENT PLACEMENT
PATIENT PLACEMENT
04.2000 - 01.2001
- Responsible for assigning medical beds to patients at St. Luke’s Medical Center.
Education
Health Unit Coordinator - Administrative
Milwaukee Area Technical College
Milwaukee, WI07-1997
Skills
- Communication and interpersonal skills
- Patient scheduling
- Insurance verification
- HIPAA compliance
- Medical billing
- Medical terminology proficiency
- Electronic health records management
- Customer service
- Reliable team player
- Patient-focused care
- Compassionate
- Maintaining confidentiality
- Electronic health records
- Clinical documentation
- Adaptable
- Insurance authorizations
- Electronic medical records
- Medical terminology
- Patient triage
- Payment collection
Timeline
Advanced Medical Assistant Specialist
Vattern Affairs Clement Zablocki Medical Center
12.2023 - Current
Appeals and Grievances Specialist Marketplace (remote position)
Molina Healthcare
09.2021 - 12.2023
CUSTOMER SERVICE REPRESENTATIVE
CHIROTOUCH
06.2019 - 03.2020
FOLLOW-UP REPRESENTATIVE II (hybrid position)
AURORA HEALTH CARE
09.2004 - 06.2019
INSURANCE ASSISTANT
INSURANCE ASSISTANT
01.2001 - 09.2004
PATIENT PLACEMENT
PATIENT PLACEMENT
04.2000 - 01.2001
Health Unit Coordinator - Administrative
Milwaukee Area Technical College