Melissa Qualls

• Optimize billing, authorization, and medical records workflows to ensure timely, accurate reimbursement.
• Handled insurance verification and authorization processes for complex and specialized services.
• Review medical records to ensure compliant, accurate CPT, ICD-10, and HCPCS coding per payer and regulatory standards.
• Analyze denial trends, identify root causes, and implement corrective actions to reduce repeat denials.
• Serve as liaison between providers, coding, and billing teams to resolve documentation issues and improve chart accuracy.
• Provide guidance and training on documentation standards, coding updates, payer requirements, and workflow improvements.
• Improve claim turnaround times through process optimization and best-practice implementation.
• Ensure HIPAA compliance, audit readiness, and effective resolution of payer and patient billing issues.

Medical Claim Cider / AR Specialist

• Managed daily operations to enhance workflow, scheduling, and patient satisfaction.
• Directed multi-state credentialing and licensing for physicians, ensuring regulatory compliance.
• Complete insurance contracting, renewals, and payer relations.
• Supported multiple satellite clinic operations and maintained consistent standards across all practice locations.
• Managed scheduling, ensuring optimal use of resources and timely appointments.
• Streamlined communication between departments to improve collaboration and information sharing.
• Developed and maintained filing systems for efficient document retrieval and management.
• Assisted in implementing new procedures that increased operational effectiveness and reduced delays.
• Trained new staff on office protocols, enhancing team performance and cohesion.
• Coordinated office operations to enhance workflow efficiency and support team objectives.
• Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
• Provided administrative support to staff members, assisting with daily tasks as needed to promote productivity across the organization.
• Tracked records, filed documents, and maintained communication between clients to manage office activities.
• Served as a point of contact for clients visiting the office, providing exceptional customer service that led to increased client retention rates.
• Maintained strict confidentiality of sensitive information, upholding the highest level of professionalism at all times.
• Increased efficiency by regularly evaluating office workflows and recommending improvements as necessary.
• Oversaw maintenance requests for office equipment, ensuring prompt repairs or replacements as needed to prevent downtime.
• Managed office activities by maintaining communication between clients, tracking records, and filing all documents.
• Reconciled account files and produced monthly reports.
• Improved client satisfaction by promptly responding to inquiries and resolving issues in a professional manner.
• Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping.
• Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.