Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Affiliations
Timeline
Generic

MELISSA MYERS, CPC, CRC

Brookhaven

Summary

Results proven manager with experience in outpatient healthcare services. Demonstrated ability with proven record of streamlining processes and leading high-performing teams. Known for strong analytical skills and commitment to achieving results. Teams rely on collaborative leadership and adaptability to changing needs. Dynamic and successful leader with the ability to create innovative health initiatives to improve health outcomes and maximize revenue potential in value-based contracts.


Overview

17
17
years of professional experience
1
1
Certification

Work History

Network Quality Management/Medicare Risk Adjustment Consultant

Optum
07.2022 - Current
  • Utilize data analysis to identify and target providers who would benefit from Medicare Risk Adjustment training and documentation/coding resources
  • Utilize data analysis and consulting skills to identify deficiencies in physician encounter submission processes and develop comprehensive, provider-specific plans to increase encounter submission rates and accuracy resulting in improved outcomes and RAF performance.
  • Educate providers on how to improve their Risk Adjustment Factor (RAF) scores which measure their patients' health status
  • Reach out to physicians, medical groups, IPAs, and hospitals to build positive, long-term consultative relationships
  • Develop comprehensive, provider-specific plans for accurate reporting of chronic conditions
  • Train providers on Optum’s Risk Adjustment programs, tools and work toward the adoption of these programs into their practices
  • Collaborate with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality Care Gap education efforts
  • Utilize data analysis and consulting skills to identify deficiencies in physician encounter submission processes and develop comprehensive, provider-specific plans to increase encounter submission rates and accuracy resulting in improved outcomes and RAF performance
  • Utilize data analysis and consulting skills educating staff about quality, cost and utilization metrics and specifics relating to their practice with innovative ways for value-based contract performance improvement.

Senior Manager, Quality/Population Health (Promoted)

Christiana Care
07.2021 - Current
  • Perform review and valuation of all value-based contracts and create revenue budget and QI strategy annually
  • Established process for quality review and valuation of proposed contracts prior to execution
  • Analyzes data and make targeted recommendations on areas of focus for established benchmarks and assist in developing strategies to improve performance.
  • Responsible for coordinating, organizing, and facilitating performance improvement activities, as well as providing expertise and guidance related to performance evaluation, monitoring, and improvement methodology
  • Ensure data-driven performance management programs are designed, implemented, and sustained in a manner that supports value-based and risk contracts, and aligns with population health goals
  • Drive and facilitate cross-team collaboration to achieve improvement and sustain growth on key performance indicators
  • Support key metrics and projects associated with provider incentive plans, to include deployment of disease-based registries
  • Drives cultural adoption of improvement methodology by promoting the development and integration of systems thinking and use of improvement tools and change management techniques
  • Develop and implement new programs and strategies while enhancing the quality of the existing programs to meet the needs of the community
  • Develop strategies and goals to close gaps in care meeting contractual requirements for HEDIS, STARS, MIPS, P4P, and Total cost of Care
  • Continually assess potential risks/opportunities for improvement, and independently influencing executive leaders to act in a change behavior through negotiations and consultation that promotes issue resolution
  • Create and implement action plans and process improvements
  • Educates staff about quality, cost and utilization metrics and specifics relating to their practice with innovative ways for performance improvement.
  • Establishes a systematic approach to all aspects of the project/program to include assessment and readiness, planning, training, implementation, coaching and sustainment.
  • Recommends resources to support projects and organizational, and/or clinical service line needs.
  • Evaluates and maintains clear documentation of project achievements based on established goals.
  • Assists in the identification of issues with data collection methods, assures methods for collection meet/exceed accreditation, regulatory, and institutional standards.
  • Presents progress reports/findings on a regular basis to appropriate constituencies.
  • Generates routine and ad hoc reports as directed within required time frame.
  • Maintains competency in EHR platforms, registries, and other applications specific to duties.
  • Advance’s knowledge of current computer software and demonstrates ability to learn and utilize new technology and/or software applications and assimilate them into daily work routine.
  • Attains and maintains proficiency in data abstraction and entry.
  • ESTABLISH AND MAINTAIN POSITIVE RELATIONSHIPS WITH ALL PROVIDERS AND PAYERS

Practice Manager II

Christiana Care
09.2020 - 06.2021
  • Partner with the Clinical Leaders of Medical Group assigned practices in the management of practice operations, financial performance, quality patient care, and patient satisfaction.
  • Responsible for monthly financial and operating budget variance analytics and reporting; interprets and reports results to Medical Group executive leadership; creates and implements action plans for revenue and expense improvements meeting all Medical Group, Christiana Care, payor, and regulatory requirements including billing accuracy, labor expense and productivity, non-wage expense, denials, fee schedules, grant management, etc.
  • Monitor, distribute, and communicate practice utilization and individual physician provider billing and productivity monthly, guided by MGCC strategic goals.
  • Responsible for advancing workflow process optimization leading and championing continuous improvement projects to improve patient satisfaction of the office experience including patient access via scheduling template management, front desk experience, rooming process, check out process, etc.
  • Coordinate assigned practice relationship with the Access Center including establishing and maintaining Service Level Agreements, communication processes, and partnering in ongoing improvements.
  • Responsible for ensuring service excellence behavior and service recovery processes are consistent within all assigned practices.
  • Partner with the Clinical Leader to create, maintain, and improve clinical care and workflows in the largest primary care practice at Christiana, staff size 70. Which includes management responsibilities over Adult Medicine, Family Medicine, and Pediatric Medicine Residency programs.
  • Collaborate with other Medical Group Practice Managers, Directors, and Clinical Leaders to share and spread best practices.
  • Direct practice staff management via the site manager; responsible for employment processes and decisions regarding office staff (including orientation/onboarding); performance management; performance appraisals; office staff meetings/committees.
  • Responsible for budget purchasing approval up to $5,000.
  • Directly manages Practice Supervisor or Clinical Coordinator or Site Supervisor or other Manager/Supervisors as assigned.

Administrator, Coordinated Regional Care/Population Health

Crozer Keystone Health System
04.2017 - 09.2020
  • Work with Medical Director and Population Health Management to advance population health and improve performance on our value-based contracts.
  • Develop strategies, goals, and milestones to close gaps in care to meet contractual requirements for STARS, CPC Plus, MACRA, P4P, and Total Cost of Care.
  • Track and report performance to measure results monthly and develop action plans for noncompliant providers for quality programs such as ePass, PCMH, CPC Plus, MACRA, QIPS, and IPPIP.
  • Assist the Primary Care Implementation Team in evaluation and integration of EMR applications and processes related to PCMH and Clinical Integration into the Primary Care Practices.
  • Assess operations of practices including patient flow, turnaround of rooms, scheduling, and front office functions, provide recommendations to improve operations, efficiency to supervisor. As part of the assessment, an implementation plan is created.
  • Act as a Project Champion and Subject Matter Expert. Develop project action plans, coordinate task assignments, and follow up. Ensure that the project is delivered in accordance with established time frame, budgetary constraints, and user objectives.
  • Assist in process development and utilization of tools to enhance practice operations.
  • Work with operations focusing efforts on proper clinical practice performance improvement and practice transformation.
  • Manage Quality Care Center programs and employees. Continually assess potential risks, create and implement action plans and process improvement.
  • Subject Matter Expert and resource for all payer value-based contracts and measures for the Quality Care Center.
  • Proactively identify opportunities for improvement and independently influence business leader(s) to act or change behavior through negotiations and consultation that promotes issues resolution.
  • Act as a liaison between the MSO client and IPA entities across multiple states.
  • Ensure clinicians are well educated about the quality programs and implement specific workflows to meet initiatives and produce positive results.
  • Ensure all clinicians are compliant with company-wide initiatives including Encounter Data, HCC, and P4P Programs, and Membership Growth.
  • Engage in open face to face dialogue with clinicians to communicate/educate important issues/updates.
  • Ensure effective problem resolution and facilitate communication between the clinicians and the Clinical Integration/Population Health Team.
  • Facilitate, develop, and coordinate best practice and quality improvement activities to advance the transformation of care across the Prospect Provider Group IPA and other applicable providers.
  • Facilitate, develop, and deliver organized training (small/large groups) and webinars (live and recorded) related to the PPG IPA quality programs.
  • Manage all aspects of Medical Coding and Risk Adjustment.
  • Developed and facilitated training for both clinical and administrative staff on HCC Coding.

Revenue Cycle Manager, Cash and Verification

Fresenius Vascular Care
10.2014 - 04.2017
  • Manage all aspects of Cash and Verification for 85+ Vascular Access site offices across the US processing approximately 125,000 procedures annually, monthly revenue 27 million. Staff size 26.
  • Responsible for preparation and distribution of monthly cash reports.
  • Responsible for new joint ventures and acquisitions to ensure proper cash processes.
  • Responsible for auditing all cash posting and verification functions to ensure department is in line with compliance guidelines.
  • Human Resource responsibilities as related to management of department.

Administrator, Business Office Operations/Revenue Cycle

Crozer Keystone Health Network
12.2010 - 05.2015
  • Directed and managed all Network billing operations of $93 million in net physician revenue. Restructuring of business office resulted in increased productivity, improved annual collections, reduction in the accounts receivable days, and reports providing transparency of results to physicians and senior leadership.
  • Managed the payer credentialing for CKHN. Redesigned processes, resulting in significant reductions in write-offs for non-participating providers.
  • Participate in practice assessments, identifying opportunities for process improvement in office workflows and assisting Practice Managers in implementing Network policies and procedures.
  • Work closely with Practice Managers and Administrative Directors to ensure compliance with billing and coding regulations, including incorporating an electronic charge capture application into hospital-based practices.
  • Responsible for all hiring functions, including interviewing, selecting, reference checking, new hire orientation, communication of Human Resource policies, including disciplinary and termination actions when appropriate.
  • Work with Finance department to meet monthly reporting needs for billing, cash, and credentialing and trending data for senior leadership.
  • Committee member for implementing training/education for staff on ICD-10.

System Trainer

01.2010 - 01.2011
  • Provided training on Practice Management system to employees across the Network practices.
  • Developed training materials and calendars for all classes.
  • Tested software for system upgrades.
  • Provided system support for physician offices.
  • Responsible for implementation of system processes with all acquisitions.

Billing/AR Representative

02.2008 - 12.2009
  • Worked accounts receivable for all insurances including Medicare, Medicaid, and all third-party payers for assigned practices.
  • Shortened revenue cycle through intense account follow up, reducing the days in AR.
  • Reviewed clinical documentation with Physicians to ensure correct reimbursement by insurance companies.
  • Provided education to Physicians and staff on correct billing and coding rules.
  • Entered charges for inpatient and office encounters.

Education

Bachelor’s degree - Healthcare Administration

Widener University
Chester, PA
01.2020

Associates degree - Allied Health

Delaware County Community College
Media, PA
01.2012

Certificate - Phlebotomy

Neumann College
Aston, PA
01.2001

Skills

  • Practice Implementation/Operations
  • Stakeholder engagement
  • Process Improvement/System Training
  • Risk Adjustment/Professional Coder
  • Process optimization
  • Project Management
  • Revenue Cycle Management
  • Forecasting and reporting
  • Value-Based Contract Performance
  • Change management
  • Team leadership & development
  • Strategic planning

Accomplishments

Decreased self-pay credit balance from $660k down to $25k over the course of 8 months

Reduced payer credentialing issues from $500k down to $95k in 45 days

Implemented cloud-based care coordination platform across multiple states and EHR systems for both employed and non-employed practices within an Independent Physician Association enhancing the patient-care experience

Certification

  • Certified Professional Coder, American Academy of Professional Coders 2010
  • Certified Professional Risk Adjustment Coder, American Academy of Professional Coders 2024

Affiliations

  • American Academy of Professional Coders
  • Southeastern Pennsylvania Chapter, American Academy of Professional Coders

Timeline

Network Quality Management/Medicare Risk Adjustment Consultant

Optum
07.2022 - Current

Senior Manager, Quality/Population Health (Promoted)

Christiana Care
07.2021 - Current

Practice Manager II

Christiana Care
09.2020 - 06.2021

Administrator, Coordinated Regional Care/Population Health

Crozer Keystone Health System
04.2017 - 09.2020

Revenue Cycle Manager, Cash and Verification

Fresenius Vascular Care
10.2014 - 04.2017

Administrator, Business Office Operations/Revenue Cycle

Crozer Keystone Health Network
12.2010 - 05.2015

System Trainer

01.2010 - 01.2011

Billing/AR Representative

02.2008 - 12.2009

Associates degree - Allied Health

Delaware County Community College

Certificate - Phlebotomy

Neumann College

Bachelor’s degree - Healthcare Administration

Widener University

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MELISSA MYERS, CPC, CRC