Melodie Whitley
Temple,TX
Summary
Clinical Reimbursement Specialist with a valid State of Texas LVN License in good standing. Solid clinical, utilization review and case management experience. Proficient in Texas Medicaid with twelve years experience. Review of Quality Measures and QIPP with outstanding results. Responsible for monitoring facility practice to ensure compliance with guidelines for Medicare, Medicaid and Managed Care. To obtain the maximum reimbursement for services rendered through education, organization and my knowledge of RAI and CMS guidelines.
Overview
2
2
years of professional experience
Work History
Director of Reimbursement
Conquest Healthcare
Fort Worth, TX
05.2023 - Current
- Developed and implemented reimbursement strategies to maximize revenue.
- Ensured compliance with all applicable federal, state and local laws and regulations related to reimbursement.
- Collaborated with departments throughout the organization on issues relating to reimbursement policies and procedures.
- Assisted in developing strategies for addressing shortfalls in reimbursements due to changing market conditions.
Regional Care Management Specialist
Regency Integrated Health Services LLC
Victoria, TX
12.2021 - 05.2023
- Educating regional and staff in facility in the proper way to promote CMS rules and regulations to obtain the maximum reimbursement for the quality of care being provided.
- Tracking and reporting clincal reimbursement trend.
- Developed and implemented reimbursement strategies to maximize revenue.
- Ensured compliance with all applicable federal, state and local laws and regulations related to reimbursement.
Education
Vocational Nursing - Nursing
McLennan Community College
Waco, TX05-2004
Skills
- Proficient in educating staff in facility in the proper way to promote CMS rules and regulations to obtain the maximum reimbursement for the quality of care being provided
- Utilization Review
- Experience with tracking and reporting reimbursement trends
- Texas Medicaid proficient
- Audits to facilitate reimbursement opportunities
- Quality Measures experience
- QIPP knowledge
Timeline
Director of Reimbursement
Conquest Healthcare
05.2023 - Current
Regional Care Management Specialist
Regency Integrated Health Services LLC
12.2021 - 05.2023
Vocational Nursing - Nursing
McLennan Community College
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