Melissa Clark

Robert Half Management Resources

Credit Resolution Supervisor -

• 2009 - 2009
• Supervised staff of 9 Credit Resolution Processors and 8 Document Prep Assistants
• Brought backlog duration from 292 days to 90 days in 2 months
• Implemented several processes for improved work flow
• Worked with management team to development plan for improved accuracy in communications from corporate hospitals
• Worked with Training Department to train Credit Processors on new systems
• Worked with temp agencies to recruit and place temporary employees
• Spoke daily with members and insurance companies about refund statuses
• Trained Credit Processors regarding different types of insurance and reimbursement practices
• Managed disbursement of refund checks
• Wrote job descriptions for new staff positions and assisted in yearly staff reviews

Orthopaedics International

-

• A/R Billing Manager 2007-2008
• Reclaimed $200,000 in unpaid billings, some as old as 3 years
• Managed monthly A/R reconciliation and year-end reports
• Billed for DME prescribed by physician including slings, crutches, walkers and wheelchairs.
• Posted all incoming cash and processed refunds
• Negotiated payoffs w/attorney offices for workers' comp or personal injury law suit settlements
• Assisted with patient care including taking vitals, making appointments and getting pharmacy approvals
• Independently wrote policies and procedures for the billing department
• Scheduled and trained all needed temporary employees for billing and coding
• Obtained approvals for workers' compensation patients
• Filled in as reception and scheduler for patients
• Care Level

Orthonet

Claims/Re -

• Audit Manager 2002-2005
• Managed team of 24 HMO claims processors and re-audit clerks
• Managed staff of 44 claim processors for PT and OT workers' comp claims
• Created guidelines for claims processing that reduced claims backlog from 75 days to same-day mail receipt
• Completed the Claims & Re-Audit Department yearly financial budget of $1.75 million
• Created presentations of claim submission and reimbursement analysis
• Created procedures that improved for communication between departments
• Created multiple spreadsheets and graphs to present claims data
• Conducted staff reviews and delivered disciplinary actions

Reimbursement Analyst - January 2001 - January 2002

• Closed all year-end reports and presented to Accounting
• Close all month-end reports and presented to Accounting
• Investigated and changed protocol (procedures) for HMO patients
• Prepared separate monthly reports for department Director and VP
• Updated ICD-9 and CPT codes within the billing system
• Analyzed reimbursement trends for various radiological procedures
• Negotiated network contract fees

Chartwell Indiana

Reimbursement Manager - January 1999 - January 2001

• Managed team of 8 billers/collectors/2 cash posters/2 intake referral representatives
• Attended fair-hearings to dispute Medicare refunds with 100% success and a total refund of $1.5 Million in reimbursements
• Implemented processes that improved reimbursement collection by $50,000 per month
• Member of leadership team that completed the yearly budget for the reimbursement department and wrote the company two-year business plan
• Completed the Billing and Intake Department yearly financial budget of $300K
• Billed DME for in-home hospital beds, wheelchairs, bedside commodes, enteral feeding pumps, etc
• Managed outsourcing of DME if timeframe of usage exceeded 90 days.
• Negotiated with provider relation reps at insurance companies regarding issues with billing disputes
• Authored weekly statistics reports to analyze health plan usage and hospital referrals.
• Authored month-end and year-end closing reports
• Negotiated insurance treatment contract fees
• Updated policies and procedures for the billing department
• Trained new employees in billing and collections of pharmaceuticals
• Billed claims and posted cash
• Processed referrals for incoming patients

Tufts Health Plan

Front End Supervisor - January 1997 - January 1998

• Managed team of 40 claims processors and data entry operators
• Hands-on management in claims processing, referrals, and vertexing
• Coordinated improvements of referral process with medical directors
• Tabulated and submitted department time cards
• Worked with HR to identify internal temp staff to fill emergency needs
• Trained incoming temporary employees
• Conducted staff reviews and disciplinary actions

Maxicare Insurance

Medical Claims Examiner/Customer Service - January 1993 - January 1997

• Processed medical HMO claims
• Company representative to process Medicaid Dental claims
• Company contact for dental offices with issues regarding Medicaid dental claims
• Investigated conflicting claim information with doctors, pharmacies, and hospitals

Adminastar Federal, Inc

Customer Service Representative - January 1991 - January 1993

• Answered incoming calls from Medicare Beneficiaries
• Researched and adjusted Medicare claims
• Assisted with creation of accurate forms
• Contacted doctors to correct incomplete or incorrect claims.