Melyssa Briley
Orange,USA
Summary
Motivated and proactive Utilization Review Specialist with exceptional organizational skills and a keen analytical problem-solving ability. Known for being detail-oriented and possessing an articulate communication style. Excels at navigating complex insurance policies and medical necessity criteria, enabling effective advocacy for patients and optimization of care outcomes.
Overview
15
15
years of professional experience
Work History
Utilization Review Specialist
Cipher Billing
06.2022 - Current
- Demonstrated strong analytical skills, interpreting medical records and relevant information for utilization review purposes.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Followed all personal and health data procedures to effectively comply with HIPAA laws.
- Maintained all utilization review documentation though JIRA and EMR
- Perform peer reviews, SCA’s, retro-reviews, and appeals
- Maintain up-to-date knowledge of carrier guidelines
- Communicate necessary and timely information to our partners
- Provide training to other departments and new hires
- Audit charts and daily work to minimize errors in the revenue cycle
Admission Coordinator
Sierra By The Sea
04.2021 - 06.2022
- Handled inquiries from prospective clients to provide detailed information regarding admissions process.
- Confirmed all insurance benefits met standards of admissions as dictated by policy.
- Provided exceptional customer service during phone and email interactions with prospective clients and their families, addressing concerns promptly
- Conducted comprehensive pre-admission assessments, gathering necessary clinical information.
- Reviewed prospective admissions against ASAM criteria for admission to treatment
- Utilized Salesforce, Best Notes, Ring Central, and Medhost for case management
Admission Counselor
Akua Mind & Body
08.2019 - 02.2020
- Handled inquiries from prospective clients to provide detailed information regarding admissions process
- Provided exceptional customer service during phone and email interactions with prospective clients and their families, addressing concerns promptly
- Input new calls and contacts into HubSpot and Kipu
- Confirmed all insurance benefits met standards of admissions as dictated by policy.
- Documented all communication with clients and completed clinical assessments for program appropriateness
- Scheduled clients for admission
- Conducted thorough clinical assessments with client's to determine eligibility for admission.
Office Assistant/Scheduler
Blue Buoy School
10.2014 - 01.2017
- Answered and managed incoming and outgoing calls while recording accurate messages for new and existing clients
- Increased customer satisfaction by providing professional and courteous
- Maintained updated client files
- Handled billing and payments for accounts
- Documented each call to provide transparency with other team members for each account
- Increased customer satisfaction by providing professional and courteous front desk support
Office Manager/Dispatch
Coastal Towing
01.2010 - 01.2012
- Handled payroll and audited employee hours
- Dispatched service calls and tows to drivers
- Billed for services provided and kept records of calls
- Processed payments due for vehicle impound fees
- Collected documentation in order to release impounded vehicles
- Provided exceptional customer service when addressing client inquiries or concerns via phone calls or email correspondence.
- Streamlined office operations by implementing efficient filing systems and organizational strategies.
Education
Certificate in Medical Billing and Coding -
North Orange County Regional Occupational Program
Anaheim, CA09.2009
Skills
- Detail Oriented
- Problem Solving Abilities
- Excellent Communication
- Customer Service-Oriented
- 45 WPM Typing Speed
- Data Entry
- Billing Knowledge
- Medical Necessity Criteria
- Private Insurance Policies
- Utilization Management
- Clinical assessment
- Insurance Verification
- Documentation And Reporting
- InterQual, ASAM & MCG Guidelines
Timeline
Utilization Review Specialist
Cipher Billing
06.2022 - Current
Admission Coordinator
Sierra By The Sea
04.2021 - 06.2022
Admission Counselor
Akua Mind & Body
08.2019 - 02.2020
Office Assistant/Scheduler
Blue Buoy School
10.2014 - 01.2017
Office Manager/Dispatch
Coastal Towing
01.2010 - 01.2012
Certificate in Medical Billing and Coding -
North Orange County Regional Occupational Program
Similar Profiles
CHRISTOPHER SANDOVALCHRISTOPHER SANDOVAL
Utilization Review Specialist at Cipher BillingUtilization Review Specialist at Cipher Billing
Jennifer MorenoJennifer Moreno
Accounts Receivable Specialist at Cipher BillingAccounts Receivable Specialist at Cipher Billing
Lindsay SolbergLindsay Solberg
Claims Manager at Indigo BillingClaims Manager at Indigo Billing
Catherine Elizabeth MoralesCatherine Elizabeth Morales
University Treble Choir President at Chapman University College of Performing ArtsUniversity Treble Choir President at Chapman University College of Performing Arts
Terrell MartinTerrell Martin
Special Education Department Head at Bob Hope SchoolSpecial Education Department Head at Bob Hope School