Melissa Melvin

Experience

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  Alabama Department of Rehabilitation Services, Children's Rehabilitation Services

  Nov 2012 - Mar 2015

  D70 Project Care Coordinator

  Skilled in strategic project planning and execution, ensuring compliance and high-quality standards. Expertise in coaching and collaborating with stakeholders to expand knowledge in the development of patient-centered medical homes. Proven track record of addressing team concerns and overcoming systematic barriers for children with special health care needs (CYSHCN). Actively involved in Alabama's healthcare discussions and quality improvement initiatives.

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  Partners in Pediatrics, LLC

  Apr 2015 - Mar 2023

  Quality Improvement Manager

  As the Quality Improvement Manager at Partners in Pediatrics, I spearheaded strategic initiatives, serving as the Project Manager, Policy Writer, and Meaningful Use/NCQA-PCMH Program Manager. Responsibilities included ensuring project deadlines, leading quality improvement interventions, managing the websitee, assisted with creating marketing resources, and maintaining compliance with CMS, HEDIS measures, and NCQA/PCMH requirements. Additionally, my role involved overseeing the maintenance of Patient-Centered Medical Home (PCMH) recognition, which significantly enhanced reimbursement rates and increased revenue growth by 40% during my tenure across all lines of business. Following this role, I continued as a QI/PCMH Consultant from March to December 2023, providing ongoing expertise in quality improvement and program management. This experience showcases my ability to drive impactful initiatives and deliver consistent results. Show less

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  Centene Corporation

  Mar 2023 - May 2024

  HEDIS Pends Project Manager

  Led successful HEDIS projects at Centene Corporation via Ascendion with Care 1st Health Plan and Arizona Complete Health, showcasing strategic leadership. Assigned work and conducted regular meetings with abstractors, contributed to audit preparation, and developed effective Corrective Action Plans (CAPs) at Care1st. Transitioned to Arizona Complete Health, where I managed the PCRDD project, leading the provider data scrubbing team. Additionally, managed the pends team, resolved cases, implemented risk management, ran vendor and internal reports for data analysis, and optimized workflow, ensured compliance and quality assurance. Utilized analytical skills to monitor compliance rates for Medicare, Medicaid, and Marketplace insurance lines of business. This experience demonstrates a track record of excellence in managing complex projects. Show less

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  Globe Life - Liberty National Division

  Jul 2024 - now

  Independent Agent