Melissa Rees
Kelso
Summary
Articulate and focused individual with proven expertise in motivating people/colleagues to achieve goals, while also prioritizing and strategizing for company’s success. Self-motivated, dynamic professional with diverse credentials, which combine solid, tactical leadership, and customer service expertise with a strong business background
Overview
22
22
years of professional experience
1
1
Certification
Work History
QUALITY ASSURANCE ANALYST
TEGRIA/ACCLARA/R1
08.2021 - Current
- Audit patient records for completeness, accuracy, and appropriateness
- The audits may include but not be limited to ensuring records include the minimal required data, comparing source data to the records for accuracy, and analyzing select data in detail
- Audit department records and processes related to general department functions including, but not limited to, billing, training, policy management, and regulatory records
- Mentored and coached team members on QA topics and strategies.
- Complete audits according to an established audit schedule and audit procedures
- Maintain detailed auditing data including workload details and documented audit findings, recommendations, and corrections in a manner that will allow this data to be categorized, tracked, and trended for analytics
- Inform and educate staff of audit findings, recommendations, and corrections
- Report audit findings, recommendations, and corrections to internal leadership
- Establish auditing goals, expectations, and benchmarks and ensure these are met or exceeded
- Participated in regular meetings with cross-functional teams to discuss progress updates, communicate concerns or challenges, and ensure alignment of project goals.
ACCOUNTS RECEIVABLE SPECIALIST
PROVIDENCE HEALTH & SERVICES
11.2014 - 01.2021
- Verify insurance coverage on various websites and by phone for commercial, Medicare and Medicaid
- Accurately update and enter correct insurance information in EPIC system to assure claims are mailed to appropriate claims address
- Research, follow up and resolve open and pending/denied claims to reduce write offs and help reduce A/R within timely filing deadlines
- Concisely and accurately document all information in patients accounts
- Supported month-end closing activities by reconciling accounts, preparing reports, and analyzing trends in account performance.
- Reduced outstanding accounts receivable balances by diligently following up on overdue payments.
Referral Coordinator
RS Medical
04.2014 - 10.2014
- Provides incremental sales coverages, particularly when a key field sales position becomes vacant
- Responsible for managing upfront benefit verification, work with payers to get authorization
- Manages all patient referrals from physicians, payers and self-pay patients within assigned territory
- Maintains & increases sales from existing referral sources
- Financial counselor to patients, advise patients of out of pocket costs, based off of their benefits
- Demonstrated strong attention to detail and organizational skills in managing a high volume of referrals while maintaining exceptional levels of patient care.
- Scheduled appointments with specialists on behalf of clients.
Senior Coordinator/Medical Quality Advancement
Office Team/Banfield Pet Hospital
08.2013 - 03.2014
- Evaluate Client Advocate Team alerts to determine if a case meets criteria for medical team review
- Coordinate formal invites with Medical Directors and hospitals regarding peer review utilizing standard templates
- Remote into nationwide hospital system to review and pull medical records and enter data into database
- Provide administrative and project support to the CTS Medical Quality Advancement teams
Sales Operations Specialist
RS Medical
10.2002 - 02.2013
- Manage accounts; provide support services to the organizations outside sales force including inventory management and allocation for specialized product, order integrity and problem solving, sales coaching and product training support
- Perform cross-functional collaboration to accomplish project objectives; cultivate and nurture professional relationships with Regional and Account Managers
- Manage and maintain positive communications with physicians, patients and sales representatives
- Apply knowledge and participate in training new employees as requested by management
- Manage documentation requirements and audit chart notes to ensure accurate information is received
Education
High School Graduate -
Evergreen High School
Vancouver, WA01.1995
Skills
- Claim processing
- Payer Reimbursement
- Quality Assurance
- Insurance verification
- Training/Auditing
- Relationship Building
- A/R Follow Up
- Medical Record Review
- MS Office Suite
- CRM
- DME2
- EPIC
Certification
- HIPPA Certified
- Pet Ware
- EPIC
Timeline
QUALITY ASSURANCE ANALYST
TEGRIA/ACCLARA/R1
08.2021 - Current
ACCOUNTS RECEIVABLE SPECIALIST
PROVIDENCE HEALTH & SERVICES
11.2014 - 01.2021
Referral Coordinator
RS Medical
04.2014 - 10.2014
Senior Coordinator/Medical Quality Advancement
Office Team/Banfield Pet Hospital
08.2013 - 03.2014
Sales Operations Specialist
RS Medical
10.2002 - 02.2013
High School Graduate -
Evergreen High School
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