MELISSA KAY SMITH

ad118j@r.postjobfree.com 423-***-****

Dalton, GA 30720

PROFESSIONAL SUMMARY

Highly Effective Leader Professional Office Management - Staff Supervision and Management - Relationship Management Consistently achieved performance improvements by clearly communicating vision, instilling team culture, and igniting potential drive. Familiar with Medicaid, Medicare, provisions encompassed with extensive experience with group medical, dental, vision, and hospital claims. Promoted sharp business focus complemented by customer orientation and strong foundation ni strategic business solutions. PROFESSIONAL VALUE OFFERED Data Processing Computer Operations Performance and Process Improvement Researching Training and Development Problem Solving and Analysis Quality and Accuracy Assurance Community

Relations Interpersonal &Corporate Communication - Key player ni applying efficient and effective communication channels and in delivering the highest level of customer service to diverse customers. Highly skilled ni communicating with people outside the organization, representing the organization to customers, the public, and other external sources. Integrity, Persistence, and a Competitive Spirit - Consistently meets deadlines and achieves goals by using measured judgment ot deliver results. Commits ot learning, wiling ot seek information, promotes independent work habits, and serves ot produce well-defined research, to create superior reports, and to hone communications ot a high professional level. Reputation as a Company Achiever - Reflects capacity to pursue business objectives, maintain focus, and motivate others to meet goals. Possess spirited optimism, self-discipline, and work ethic. Exceptional Motivator and Strategist - Motivates and mentors team members using positive and practical approaches promoting can-do and hands-on work philosophies with employees. Performance Management - Asserts that goals assigned are directly aligned with the goals from the strategic and business plans of the organization, and further refine goals by doing various task and job analysis to identify what competencies (knowledge, skills and abilities) are needed to achieve the goals.

SKILLS

• MICROSOFT OFFICE, OUTLOOK, WORK, EXCEL, ACCES, POWER POINT

: FiveAentdance

Monotnirg • Problem-Solving

• Training Assistance

• Team Leadership

• Team Supervision :SertngVerbal aWnentid Communication

• Daily Workflows

WORK HISTORY

LINCARE DME - LEAD HELD SALES 01/2018 - 10/2023

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I am currently responsible for keeping revenue down for 5 centers for Lincare

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This position requires me to interact with providers, nurses, and the

toward DME products

Wellcare Of Georgia - RS OAR Atlanta, GA • 01/2014 - 11/2022

: Sespensile ni peting serialist ot, nae deung set, b

nilg ro claims issues

EDUCATION

CHATTANOOGA GED

ECPC BUSSINESS MANAGEMENT/COMPUTER PROGRAMMING REVENUE CYCLE BUILDERS CPC-ICD10/MEDICAL

TERMINOLOGY CLASSES

• Discussed Hedis scores with Providers, as well as office

management, Always reviewed ER report before each visit to asses fi there would be a need to discuss providers members utilizing the ER more than the office for unnecessary visits

• fI so, these would be printed, and discussed with the provider and necessary staff

• Serve as a liaison between the insurance company and customers to explain coverage terms and answer questions

• Serve as the point of contact for providers for orientation, on-going training, and technical support

• Initiate responses to provider requests/ needs and identify network trends and gaps as it relates to provider questions and concerns

• Negotiate provider contracts as applicable and participate in quarterly Provider Forums

• Schedule and conduct/participate ni quarterly provider visits while providing input for the provider manual

• Communicate any new or updated policy and/or procedure to Ersuiteal provdier distribution lists dea mistered, dna adher ot department operating routines, including policy and procedures, communication and customer service.

Peach State Hith Plan, 360 United Health Group - Provider Relations Rep

01/2017 - 01/2018

• Responsible for Providers currently contracted, as well as obtaining new contracts to close care gaps, for approx. -45 counties within the Northern Region of Georgia

The company currently offers a Medicare Advantage Plan, which offered 3plan products, (MAPD)-Medicare with drug, (CSNP)- Medicare A+B with chronic conditions, and (DSNP)- Medicare both A+B and also receives assistance through their state of residence.Medicaid plan, as well as a Medicare Plan

Responsible for making sure al providers were trained on the new

plan, and our billing systems

Responsible for making sure those providers were trained on our

Better Health for You Booklet, ni order to maintain the State Hedis MRA Risk Scores, and to obtain a Five Star Ratings

• Medicare Claims Specialists- Optium

PR REP - CLAIMS PROJECT SPECIALISTS 01/2010 - 01/2011

• Led large-scale, high-impact projects from start to finish with minimal or no supervision to achieve specific training goals.

Brought positive attitude to orientation and educational programs to improve learning environment.

Identified department needs, developed training materials and implemented strategies to prepare employees thoroughly for job demands.

Worked independently with minimal supervision, setting priorities and demonstrating excellent project management skills.

Consulted with various business unit leaders, keeping pulse on business to identify training needs and coordinate learning solutions. Collected and analyzed data to determine ROl or ROE, contributing to evaluation of training courses and program effectiveness.

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Frecensius Medical Care - Patient Account Representative 01/2006 - 01/2008

• Reviewed patient's account and ensured that charges were accurate

• Collected the patient's payment after services have been rendered • Communicated with the patient's insurance company to ensure services were approved for payment

Provided suggestions or assistance to patients applying for health care resources, such as Medicaid

Provided outstanding customer service to the patients and their families, assuring that the patients and their families understood

their financial responsibilities

• Set up patient budgets and post patient payments to patient

accounts accordance with the Centers policies •Confirmed patient insurance eligibility and/or benefits, and generated patient statements

• Determined required deposits, and followed up to make sure payments were made ni accordance ot Centers policy

Audited charts for correct income verification process and corrected bad addresses ni NextGen patient account and maintained address log

• Adjusted bad patient checks of and entered notes ni practice management system

• Discussed and educated family members on various services offered by the Center and methods fo payment for those services including but not limited to Medicare, Medicaid, Insurance and Private Pay.

Blue Cross Blue Shield of Tennessee - Team Leader/Data Processor I 01/1996 - 01/2004

• Leader responsible for inputting various types of information including documents, statistics and the like into employer's content management system

• Responsible for working all lines of commercial claims and over seen short term disability, long term disability, and al workers computation claims

• Gathered and sorted information and entered into the database

• Examined documents for accuracy while performing other administrative tasks, such as answering telephones, sorting mail and

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