Melissa R.

About Melissa R.

I have 34 yrs. of experience in healthcare, primarily in Operations management and Revenue Cycle Management. I have had extensive experience in preparing medical Professional and Institutional claims for payment in which I handled and prepared in repricing for In/ out network claims for a TPA. I also have FQHC Director of Credentialing and Project Management. Performed billing of 32 different specialties, In/ Out of network to include; Appeals, Denied Claims. Prior Auth, Precertification of Surgical procedures, and have Taught Medical Billing, ICD/ CPT and HCPCS Coding and law and ethics. Great experience in complete practice start ups, restructuring and managed several outpatient medical faciliies in the Houston area that were primarily ASC out patient facilities. I have recruited Physicians and Allied Health specialist, Admin Staff to include general HR, benefits coordinator and Payroll. Hiring, training to include mentoring. Credentialing of Managed care organizations, State and Governement programs such as Medicaid, Medicare for Individual physicians, Group practices and Deligated groups. Credentialing of Hospital staff privilages for physicians and Allied health professionals. This includes the other end of the spectrum in verifying the professionals back ground through National Data Bank system, Peer references and Academic verification. I am not Clinical in background, but offer a variety of Business experience and hands on knowledge of performing all the tasks mentioned.

Experience

1. Healthcare Operations Manager

   Independent Consultant

   Apr 2022 — Present · US

Education

• AAPC

  Member, Coding

  1996 — 2022

• San Jacinto College

  Medical/Health Management and Clinical Assistant/Specialist

  1996