Melissa Robinson
Health Administration
Palm Coast,USA
Summary
Accomplished healthcare professional with comprehensive expertise in healthcare administration, specializing in credentialing verification, provider enrollment, claims processing and adjudication, and revenue cycle.
Overview
15
15
years of professional experience
1
1
Certification
Skills
- Credentialing processes and provider enrollment
- Claims review and insurance collaboration
- Onboarding, background checks, and license verification
- Problem-solving aptitude and critical thinking
- Onboarding process
- Epic, Facets, and OnBase expertise
- HIPAA compliance
- Insurance procedures
Work History
Revenue Cycle Specialist
AdventHealth
Daytona Beach, FL
03.2025 - Current
- Analyzed claims data to identify trends in denials and rejections.
- Performed account reconciliations between insurance companies and internal systems.
- Monitored daily account work queues to determine necessary follow-up actions.
- Researched payer denials on unpaid invoices and executed reconciliations.
- Maintained up-to-date knowledge of insurance policies, procedures, regulations, and guidelines.
Consumer Experience Specialist
AdventHealth
Ormond Beach, FL
03.2024 - 03.2025
- Compiled and analyzed daily performance reports from consumer dashboards, detailing key patient satisfaction metrics.
- Developed successful resolutions for complex concerns, aligning with business requirements and customer needs.
- Organized workshops and seminars to enhance professional development opportunities for staff members.
- Communicated regularly with Consumer Experience Team regarding project progress, escalating budget or timeline issues.
- Conducted on-site visits with AdventHealth Medical Group practices to share insights and solutions for consumer initiatives.
Enrollment Specialist
CareSource via Calculated Hire
Remote, Florida
11.2023 - 03.2024
- Calculated premiums and established payment methods while managing new enrollments through data entry and verification.
- Resolved eligibility issues by researching member qualifications across all systems.
- Processed mass changes for Primary Care Physicians within Provider Operations efficiently.
- Reviewed and interpreted eligibility data to address inquiries from contracted vendors.
Collections Specialist I
Davita Labs
DeLand, FL
01.2023 - 11.2023
- Served as point of contact for collection follow-ups on claim denials with insurance payers.
- Researched claims and appeals, resolving rejections and underpayments effectively.
- Drafted appeal letters to insurance companies to rectify denial issues.
- Collaborated with multiple departments during entire collection process to ensure efficiency.
- Conducted outbound calls to recover past-due balances from insurers and third parties.
Credentialing Coordinator
Brave Health
Remote, Florida
10.2022 - 12.2022
- Created and maintained provider credentialing information using Symplr, CAQH, NPDB, ABMS, CMS, NPPES, DEA, and OIG.
- Collaborated with departments to support onboarding and credentialing of new providers.
- Verified adherence to requirements through follow-ups with licensees.
- Monitored and tracked credentialing application progress to ensure timely completion.
Data Analyst
UF Health Shands
Jacksonville, FL
11.2017 - 03.2022
- Collected and prepared data reports for over 300 infants monthly to determine RPICC eligibility.
- Presented trends to stakeholders across departments to develop strategies using healthcare analytics.
- Coordinated data retrieval with teams for special projects, including four-year RPICC On-Site Review.
- Achieved excellent standards for biannual RPICC Desk Reviews and Annual RPICC Reviews for four consecutive years.
- Maintained comprehensive databases of patient histories, medications, laboratory results, and insurance claims.
Provider Enrollment
Priority Health
Grand Rapids, MI
11.2010 - 09.2017
- Conducted extensive communication with internal and external network contacts for credentialing and onboarding physicians and new graduates.
- Performed verification checks for new provider enrollments per company policies and procedures.
- Reviewed and updated provider enrollment applications to ensure accuracy and completeness.
- Guided providers through enrollment processes, timelines, and requirements, addressing inquiries regarding credentialing status.
- Supported members in navigating enrollment processes to facilitate informed decisions.
- Resolved over 60 provider claim issues daily, achieving a 99% accuracy rate.
- Trained and audited approximately 15 team members on pended claims and provider enrollment over two years.
- Monitored and updated provider maintenance account system issues.
Education
Master of Science - Health Administration
Ohio University
Athens, OH04.2022
Certification
CPHQ
Timeline
Revenue Cycle Specialist
AdventHealth
03.2025 - Current
Consumer Experience Specialist
AdventHealth
03.2024 - 03.2025
Enrollment Specialist
CareSource via Calculated Hire
11.2023 - 03.2024
Collections Specialist I
Davita Labs
01.2023 - 11.2023
Credentialing Coordinator
Brave Health
10.2022 - 12.2022
Data Analyst
UF Health Shands
11.2017 - 03.2022
Provider Enrollment
Priority Health
11.2010 - 09.2017
Master of Science - Health Administration
Ohio University
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