Misty Bell
Bessemer City,NC
Work Preference
Summary
Dynamic Clinical Manager with a proven track record at Carolinas Weight Loss Institute, specializing in clinical oversight and staff training. Demonstrates expertise in enhancing patient communication and improving clinical quality outcomes through strong analytical skills. Committed to driving process improvements and ensuring regulatory compliance, fostering exceptional patient relationships and team success.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Clinical Manager
Carolinas Weight Loss Institute
Gastonia
07.2023 - Current
- Managed daily operations of clinical weight loss programs.
- Developed training materials for new clinical team members.
- Facilitated communication between patients and healthcare providers.
- Intervened on behalf of patients when necessary to ensure optimal outcomes.
- Interacted with patients, asked appropriate questions and listened carefully to deliver high level of clinical care.
- Delegated tasks to each member of staff and oversaw task completion, offering assistance to promote success.
- Provided clinical oversight for many patients.
- Supervised staff in the delivery of patient care services.
- Spearheaded clinical training and orientation for newly hired staff and university students.
Sr. Complaint and Appeals Analyst
Aetna, a CVS Health
Gastonia
04.2000 - 07.2023
- Reviewed claims and appeals for accuracy and compliance with regulations.
- Analyzed data trends to identify potential issues in claims processing.
- Collaborated with healthcare providers to resolve complex claim disputes.
- Facilitated communication between members and internal departments for appeal resolutions.
- Prepared detailed reports on appeal outcomes and process improvements.
- Utilized case management systems to track appeal status and documentation efficiently.
- Analyzed and evaluated appeals to ensure compliance with applicable laws, regulations, policies and procedures.
- Assisted patients with insurance questions by studying benefits.
- Drafted correspondence responding to inquiries from internal and external stakeholders regarding the status of individual claims or general policy questions.
- Reviewed documents for accuracy and completeness prior to processing appeals.
- Provided guidance and assistance to other departments regarding the appeals process.
- Attended meetings with management staff concerning policy changes impacting the appeals process.
- Actively monitored progress on pending appeal cases ensuring timely completion of tasks associated with each claim dispute resolution.
- Assisted in developing new processes designed to improve efficiency within the Appeals department.
- Maintained accurate records of all activities related to the appeals process.
- Prepared detailed reports summarizing appeal results.
- Coordinated with various departments when additional information was required for a successful resolution of an appeal.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
Education
Chiropractic Assistant
Carolina Chiropractors
Welcome, NC03-2024
Emergency Medical Technician
Gaston College
Dallas, NC07-2005
High School Diploma -
North Gaston High School
Dallas, NC06-1996
Skills
- Clinical oversight
- Training development
- Patient communication
- Staff supervision
- Regulatory compliance
- Claims processing
- Data analysis
- Process improvement
- Customer relationship management
- Attention to detail
- Effective leadership
- Time management
- Conflict resolution
- Insurance billing
- Effective communication
- Administrative oversight
- Patient relationship management
- Improving clinical quality outcomes
Accomplishments
- Beta Club Member
- Ranked in top 5% of my graduating class
- Awarded Naval Honor for my accomplishments in mathematics
Certification
- Board Licensed Chiropractic Assistant in NC
References
References available upon request.
Timeline
Clinical Manager
Carolinas Weight Loss Institute
07.2023 - Current
Sr. Complaint and Appeals Analyst
Aetna, a CVS Health
04.2000 - 07.2023
Chiropractic Assistant
Carolina Chiropractors
Emergency Medical Technician
Gaston College
High School Diploma -
North Gaston High School