Melissa Mullins
COB MSP Representative I
Charleston,West Virginia
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
21
21
years of professional experience
Work History
COB MSP Representative I
CareFirst BlueCross BlueShield
10.2019 - Current
- Assisted in training new hires and offered ongoing support to help them reach their full potential.
- Developed effective improvement plans in alignment with goals and specifications.
- Investigate and analyze Medicare Secondary Payer demands for coordination of benefits with Medicare.
- Updating/maintaining accurate file information regarding other party liable to ensure correct coordination occurs with Medicare.
- Reviews cases to determine primary liability and makes necessary adjustments. Research claims history in order to identify previously paid claims.
- Determines liability based on timely filing guidelines and contractual benefits.
- Attention to detail and excellent analytical and problem-solving skills have aided in my perfect quality scores.
- Prior to being promoted to COB department I was a Customer Service Advisor after attending 12 week training program, where assisting our member and/or providers with the support required to resolve cases.
- Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable.
- Appropriately documents all client interactions according to established departmental procedures. Examines adjudicated claims to identify key elements and processing requirements based on diagnosis, procedure, provider, medical policy, contracts and policy procedures.
- I was chosen to work many reports including but not limited to the First Call Resolution due to my attention to detail and high quality scores.
Career Counselor
Charleston Job Corps Center Horizons Youth Service
08.2018 - 10.2019
- Helped determine possible vocations and build application documents.
- Promoted diversity awareness in an inclusive environment by incorporating multicultural elements into programming efforts.
- Developed strategic plans aligning departmental goals with institutional objectives to ensure long-term growth and success.
- Maintained quality control standards.
- Review detailed background file, conduct personal interview and test as necessary to analyze and recommend a program for each assigned student.
- Provide continuous educational, career technical training, personal and social adjustment counseling on an individual and group basis.
- Recommend necessary program modifications throughout the stay of each assigned student. Conduct continuous interpretation and evaluation of progress in student's specific development program.
- Coordinate problem cases and point out areas in which guidance and development techniques can be improved.
- Maintain documentation and records
- Utilize new concepts and approaches; recommend and conduct training sessions and conferences to develop greater proficiency among staff in areas of guidance and social adjustment.
- Recommend medical or psychiatric evaluation for emotional or psychological problems. Evaluate results and take remedial action as warranted. Refer students to other program areas as appropriate and necessary.
- Serve on career management teams and 60 day evaluations; participate in other center programs such as career preparation, multi-cultural committee, trainee employee assistance program and pregnancy programs. Maintain contact with student's family and admission counselors. Utilize community resources as needed.
- Enhanced community outreach to bring in new candidates, highlight programs and meet targets
Intake Representative, Claims
Brickstreet Mutual Insurance
01.2015 - 05.2018
- Responsible for collecting data while receiving the First Report of Injury from employers by telephone, email, internet and/or fax.
- Advise policyholders of the options available for reporting work related injuries. Advise policyholders and claimants of the status of a claim, if additional information is needed to complete the claim for review and assist them with completing forms. Entering and updating claim data and personal information into the database.
- Research policy information to determine coverage and jurisdiction of an injury. Answering policy and claim related questions from the policyholder, claimant and/or medical provider and replying via email, phone, fax and/or correspondence.
- Facilitated smooth transitions between different stages of care by effectively coordinating necessary steps during the intake process
- Resolved escalated issues with professionalism and empathy, earning trust from both colleagues and clientele alike
Executive Office Data Operator
West Virginia State Police
04.2009 - 01.2015
- Reduced manual data entry workload by leveraging automation tools and scripting techniques.
- Handled a high volume of complex alphanumeric entries without compromising quality or accuracy standards.
- Participated in cross-functional projects requiring extensive data analysis, contributing valuable insights based on findings.
- Expedited project completion by consistently meeting or exceeding data entry quotas and deadlines.
- Identified errors on source documents and made necessary corrections.
- Certified in the WEAPON and Appalachia HIDTA SafeTNet/Deconfliction programs as well as the OASIS Training Coordinator.
- Working closely with Human Resources to ensure accuracy of personnel records, updating reporting locations and ranking/classifications for department. Maintaining tenure dates, Military Leave, Accrued Annual, Sick and Family Sick Leave, pro-rating leave increments when an employee was off payroll due to being on Leave Without Pay.
- Working closely with the Programmer for Information Technology Services developing new data system. Entering new employee's personnel information into Virtual Office to coordinate security access and job-related accounts were created and removing personnel when separated from the Department.
- Overseen the production, quality and hours of two part time employees.
Senior Medical Claims Examiner
Wells Fargo Third Party Administration
06.2003 - 04.2009
- Managed large volume of medical claims on daily basis.
- Expertly navigated disputes between parties involved in the claiming process, leading to fair resolutions.
- Verified accuracy of medical records to maintain accuracy of records database.
- Client contact for Perdue Farms, Inc to ensure all their needs were met: corresponding by email and phone.
- Processing all VIP claims, documenting the examiner and customer service applications, creating and following up on adjustments, logging all the out of network exceptions on an Excel spreadsheet, filing and maintaining all documentation and helping wherever needed.
- Due to my quality and production, I won the Quality Quest Examiner of the year.
Education
Bachelor of Arts - Business Administration
West Virginia State University
Institute, WVSkills
Timeline
COB MSP Representative I
CareFirst BlueCross BlueShield
10.2019 - Current
Career Counselor
Charleston Job Corps Center Horizons Youth Service
08.2018 - 10.2019
Intake Representative, Claims
Brickstreet Mutual Insurance
01.2015 - 05.2018
Executive Office Data Operator
West Virginia State Police
04.2009 - 01.2015
Senior Medical Claims Examiner
Wells Fargo Third Party Administration
06.2003 - 04.2009
Bachelor of Arts - Business Administration
West Virginia State University