Melissa Yang
Conover,NC
Summary
Healthcare Administrator with proven to deliver exemplary level of healthcare service delivery to patients. Coordinate admission and discharge of patients. Plan and implement strategies for developing improved health care management. Proven problem solver and excellent communicator. Strong organizational skills, superb understanding of data collection and performance metrics.
Overview
8
8
years of professional experience
2
2
Certifications
Work History
Utilization Management Reviewer
Centene
Sacramento , CA
02.2022 - 02.2023
- Initiate authorization requests for output or input services with prior authorization list, screen for eligibility and benefits, coordinate services with community-based organizations, data enter assessments and authorizations into systems, attend outreach meetings to represent health plan, contact member’s attending PCP, POA, home health agencies, or equipment vendors for information to process claims, Approving or denying claims based on health plan guidelines.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
Behavioural Health receptionist
NVIH Clinic
Chico, CA
03.2021 - 07.2021
- Maintaining data entry on spreadsheets via EXCEL to organize each checked in patients’ health insurance.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Checked patient insurance, demographic, and health history to keep information current.
- Organized paperwork such as charts and reports for office and patient needs.
- Managed multi-line phone system and pleasantly greeted patients.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Invoiced patients accurately in line with charging guidelines.
- Supported office staff and operational requirements with administrative tasks.
COVID-Tracer
Butte County
Oroville, CA
01.2021 - 03.2021
- Answering multi-line telephones up to 50 callers per day to assist members with any COVID related inquiries, maintaining system knowledge in order to navigate properly and handle member inquiries efficiently, scheduling COVID vaccine appointments.
- Lent daily assessment of health screen and symptom data.
- Notified and interviewed individuals to ascertain novel coronavirus exposure level.
- Contacted clients in person, by phone or in writing to ascertain compliance with required or recommended actions.
- Collaborated with local organizations to expand health services and resources.
- Cultivated interpersonal skills by building positive relationships with others.
Education
Paralegalism Program/Certificate -
San Joaquin College
San Joaquin, CAEastern Gateway Comm. College
Skills
Documentation and reporting
Patient care plans
Interpersonal and written communication
Relationship building and retention
Multidisciplinary team collaboration
Certification
Medical Billing and Coding
Timeline
Medical Billing and Coding
05-2023
CPR/Basic First Aid
12-2022
Utilization Management Reviewer
Centene
02.2022 - 02.2023
Behavioural Health receptionist
NVIH Clinic
03.2021 - 07.2021
COVID-Tracer
Butte County
01.2021 - 03.2021
Paralegalism Program/Certificate -
San Joaquin College
Eastern Gateway Comm. College