MELISSA MYERS, CPC, CRC
Brookhaven
Summary
Versatile manager in outpatient healthcare services, with a proven track record of enhancing operations through effective population health strategies, revenue management, and cost-reduction initiatives. Strong leadership skills demonstrated through the development of innovative health programs that improve outcomes and optimize revenue in value-based contracts. Experienced in coordinating diverse teams and managing complex projects, with expertise in strategic planning and operational improvement. Achievements include implementing solutions that significantly increased efficiency and productivity while upholding high quality standards.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Network Quality Management/Medicare Risk Adjustment Consultant
Optum
07.2022 - Current
- Conducted data analysis to identify providers needing Medicare Risk Adjustment training and resources.
- Developed comprehensive, provider-specific plans to enhance physician encounter submission rates and accuracy.
- Educated providers on improving Risk Adjustment Factor (RAF) scores to better reflect patient health status.
- Established consultative relationships with physicians, medical groups, IPAs, and hospitals for long-term collaboration.
- Created tailored plans for accurate reporting of chronic conditions among providers.
- Trained providers on Optum’s Risk Adjustment programs to facilitate successful integration into practices.
- Collaborated with internal and external stakeholders on wide-ranging Risk Adjustment and Quality Care Gap education initiatives.
- Employed data analysis to inform staff about quality metrics and innovative strategies for value-based contract improvements.
Senior Manager, Quality/Population Health (Promoted)
Christiana Care
07.2021 - Current
- Conducted annual reviews and valuations of value-based contracts to create revenue budget and QI strategy.
- Established quality review processes for proposed contracts prior to execution.
- Analyzed data and provided targeted recommendations to enhance performance against established benchmarks.
- Coordinated and facilitated performance improvement activities, offering expertise in evaluation and monitoring methodologies.
- Designed and implemented data-driven performance management programs aligned with population health goals.
- Drove cross-team collaboration to sustain growth on key performance indicators.
- Developed strategies to close care gaps meeting HEDIS, STARS, MIPS, P4P, and Total Cost of Care requirements.
- Educated staff on quality metrics and innovative performance improvement techniques.
Practice Manager II
Christiana Care
09.2020 - 06.2021
- Partnered with Clinical Leaders to manage practice operations and enhance financial performance.
- Conducted monthly budget variance analysis, reporting results to executive leadership and implementing action plans.
- Monitored and communicated practice utilization, individual physician billing, and productivity aligned with strategic goals.
- Championed workflow process optimization through continuous improvement projects to boost patient satisfaction.
- Coordinated relationships with Access Center, establishing Service Level Agreements and communication processes.
- Ensured consistent service excellence behaviors and recovery processes across all assigned practices.
- Collaborated with Medical Group managers and directors to share best practices for operational efficiency.
- Managed staff employment processes, performance evaluations, and office staff meetings as directed.
Administrator, Coordinated Regional Care/Population Health
Crozer Keystone Health System
04.2017 - 09.2020
- Collaborated with Medical Director and Population Health Management to enhance population health and improve value-based contract performance.
- Developed strategies and milestones to address care gaps for STARS, CPC Plus, MACRA, P4P, and Total Cost of Care requirements.
- Tracked and reported monthly performance metrics to create action plans for noncompliant providers in quality programs.
- Assisted Primary Care Implementation Team in evaluating EMR applications for PCMH and Clinical Integration within practices.
- Assessed practice operations, including patient flow and scheduling, providing recommendations for efficiency improvements.
- Served as Project Champion and Subject Matter Expert, ensuring timely project delivery within budgetary constraints.
- Managed Quality Care Center programs, identified risks, and implemented process improvement action plans.
- Educated clinicians on quality programs and ensured compliance with Encounter Data, HCC, and P4P initiatives.
Revenue Cycle Manager, Cash and Verification
Fresenius Vascular Care
10.2014 - 04.2017
- Oversaw cash and verification operations for 85+ Vascular Access sites, processing approximately 125,000 procedures annually with monthly revenue of $27 million.
- Managed a team of 26 staff members to maintain efficient cash handling processes.
- Prepared and distributed monthly cash reports to facilitate financial oversight.
- Directed new joint ventures and acquisitions to implement effective cash management protocols.
- Audited all cash posting and verification activities to ensure compliance with regulatory guidelines.
- Handled human resource functions related to department management, optimizing team performance.
Administrator, Business Office Operations/Revenue Cycle
Crozer Keystone Health Network
12.2010 - 05.2015
- Directed and managed Network billing operations generating $93 million in net physician revenue.
- Restructured business office, increasing productivity and improving annual collections while reducing accounts receivable days.
- Managed payer credentialing for CKHN, redesigning processes to significantly reduce write-offs for non-participating providers.
- Participated in practice assessments, identifying and implementing process improvements in office workflows.
- Collaborated with Practice Managers and Administrative Directors to ensure compliance with billing and coding regulations.
- Oversaw all hiring functions, including interviewing, reference checking, and new hire orientation.
- Coordinated with Finance department to fulfill monthly reporting requirements for billing and cash flow.
- Served on committee to implement staff training on ICD-10 compliance.
System Trainer
Crozer Keystone Health Network
01.2010 - 01.2011
- Delivered training on Practice Management system to employees across Network practices.
- Developed comprehensive training materials and schedules for all classes.
- Conducted software testing for system upgrades to ensure functionality.
- Provided technical support for physician offices, resolving system issues promptly.
- Implemented system processes during acquisitions to facilitate seamless integration.
Billing/AR Representative
Crozer Keystone Health Network
02.2008 - 12.2009
- Managed accounts receivable for all insurance types, including Medicare and Medicaid.
- Reduced days in accounts receivable through rigorous account follow-up.
- Reviewed clinical documentation with physicians to ensure proper reimbursement.
- Educated physicians and staff on accurate billing and coding practices.
- Entered charges for inpatient and office encounters to maintain financial accuracy.
Education
Bachelor’s degree - Healthcare Administration
Widener University
Chester, PA01.2020
Associates degree - Allied Health
Delaware County Community College
Media, PA01.2012
Certificate - Phlebotomy
Neumann College
Aston, PA01.2001
Skills
- Value-based contract performance
- Employee management
- Process improvement
- Stakeholder engagement
- Forecasting and reporting
- Budget management
- Change management
- Strategic planning
- Work prioritization
- Data analysis
- Process optimization
- Project leadership
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
- Successfully reduced outstanding accounts receivable greater than 90 days from 25% to 18%
- Reduced hospital readmissions by 20%
Affiliations
- American Academy of Professional Coders
- Southeastern Pennsylvania Chapter, American Academy of Professional Coders
Certification
- Certified Professional Coder, American Academy of Professional Coders, 01/01/10
- Certified Professional Risk Adjustment Coder, American Academy of Professional Coders, 01/01/24
Application Proficiency
- Microsoft Office: Outlook, Word, Excel, PowerPoint Allscripts, Athena, Cerner, eCW, Epic, NextGen, Cognos, Cognos, Qs/1, Imagine
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
Crozer Keystone Health Network
01.2010 - 01.2011
Billing/AR Representative
Crozer Keystone Health Network
02.2008 - 12.2009
Bachelor’s degree - Healthcare Administration
Widener University
Associates degree - Allied Health
Delaware County Community College
Certificate - Phlebotomy
Neumann College
Similar Profiles
Kaitlynn GalloKaitlynn Gallo
Medical Assistant at OptumMedical Assistant at Optum
Samantha RunnerSamantha Runner
Network Program Consultant at OptumNetwork Program Consultant at Optum
Jocina RosarioJocina Rosario
Coding Quality Analyst at OptumCoding Quality Analyst at Optum
Heather N. BarndtHeather N. Barndt
Supervisor at OptumSupervisor at Optum
Oliver MoranOliver Moran
Sales Associate at Soccer ShopSales Associate at Soccer Shop