1. MELANIE FLOWERS
Phone: 313-909-4748  E-Mail: mel020787@gmail.com
EDUCATION
BACHELORS IN SOCIAL SCIENCE, MINOR IN HEALTHCARE MANAGEMENT 2017
University of Maryland University College – Adelphi, Maryland, United States
PROFESSIONAL OVERVIEW
HEALTH CAREPROFESSIONAL WITH FOUR (4+) YEARS OF EXPERIENCE. HASKNOWLEDGE AND EXPERIENCEIN
HEALTH MAINTENANCE ORGANIZATIONS,MEDICAID,MEDICARE, PREFERREDPROVIDER ORGANIZATIONS,AND
HEALTH INSURANCEMARKETPLACE. SALESEXPERIENCEIN RETAIL AND CUSTOMER CARE FOR ELEVEN (11+) YEARS.
SKILLEDRESEARCHER AND ANALYST THAT MAINTAINSCOMPLIANCE ANDUNDERSTANDSHEALTH CARE
REGULATIONS. EXTENSIVEEXCEL DEVELOPMENT THAT INCLUDES SKILLSIN MAINTAINING ACCURATE EXCEL
SPREADSHEETS, WITH PROFICIENCY IN MACROS, VLOOK-UP, EXCEL ADD-INS ANDMAIL MERGE. PROFICIENT IN
MICROSOFT ACCESS QUERIES AND CREATING REPORTS. EXCELLENT INTERPERSONAL, ORGANIZATIONAL,
ANALYTICAL, AND PROBLEM SOLVING SKILLS.
PROFESSIONAL HIGHLIGHTS
PROFESSIONAL EXPERIENCE
BUSINESS ANALYST OCTOBER 2015 – CURRENT
Blue Cross Blue Shield – Detroit, MI – Contracted
 Staying in compliance with the Health Insurance Marketplace regulations to avoid fines or loss
of state contracts.
 Strong analytical skills
 Effective in a team environment
 Strong interpersonal communication
skills
 Microsoft Word, Excel, PowerPoint,
Access, and Outlook proficiency
 Medical terminology
 Two (2+) years of HEDIS extraction
 Maintain strict confidentiality
 Community Outreach
 Schedule management
 EMR and EHS proficient
 Knowledgeable in HMOs, PPOs, Medicare and
Medicaid Insurance operations
 Four (4+) years of health care experience
 Three (3+) years of collecting and analyzing
health data/reports
 Two (2+) years or training experience
 Extensive research skills
 ICD-9/10 and CPT proficient

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 Evaluating complaints to analyze whether an investigation is necessary, and when appropriate
lead and participate in those complaint investigations by conducting extensive research.
 Following up with customers to evaluate adverse events and acquire other pertinent
information as needed.
 Analyzing complaint data daily to identify possible areas for improvement for the department.
 Responding to complaints within a 14-day grace period in order to meet strict Health Insurance
Casework System (HICS) guidelines.
 Utilizing systems, such as PA250, MetaVance, NCompass, NCSW, HICS, and 834File to gather
research to resolve consumer complaints made through the Health Insurance Marketplace.
 Performing heavy volume data entry and analysis for Marketplace member’s under a large and
expanding state contract, while ensuring the data is entered correctly into multiple database
systems.
 Working as a lead on a project to execute quality assurance queries into over 900 member’s
files so incorrect issues could be identified and resolved in order to reduce audit possibilities.
 Communicating directly with members and insurance plans on a daily basis in order to resolve
benefit and claim issues, while also addressing requests from multiple internal departments
within BCBSM.
 Formally notifying members by individualized letters explaining the changes that may have
been made or may have occurred on their accounts, and when necessary offered an appeal to
have an escalation filed.
 Understanding and learning the billing portion of BCBSM to correctly explain billing errors or
billing amounts incurred on member policies.
 Assisting with training new hires for the Health Insurance Marketplace during open enrollment.
REFERRAL/PATIENT NAVIGATOR JUNE 2015 – OCTOBER 2015
Fidelis SecureCare – Detroit, MI
 Helped execute and explain the MiHealth Link program to members who were eligible to
receive both Medicaid and Medicare health care benefits.
 Navigated and documented in various electronic health Systems (eClinical Works, SAMI,
TruCare) to resolve patient and provider issues.
 Worked closely with the Utilization Management Department to resolve continuity of care
issues, while transitioning out-of-network patient’s into in-network providers.
 Helped members get approved to remain with their out-of-network providers under the
continuity of care rule.
 Utilized Microsoft Excel to create reports sectioned off by districts, case coordinators, patient
information, health risk assessment completed, and insurance enrollment dates.
 Processed patient referral’s using correct ICD-9 and ICD-10 codes in adjacent to the correct
CPT codes so authorizations could be received in a timely manner by inpatient and outpatient
facilities.
 Conducted interviews with members to identify specific health needs through the use of initial
risk screening questionnaires.
 Worked within the community to help locate members that had not been able to be reached
prior to open enrollment, and completed their required assessments and provided them with
the necessary information to local area agencies and case coordinators.

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 Created administrative and care plans that allowed for case coordinators to efficiently and
effectively determine the needs of the population the company was servicing.
LEAD MEDICAL RECORDS COORDINATOR AUGUST 2013 – MAY 2015
Western Wayne Family Health Centers – Inkster, MI
 Maintained a full-time presence receiving, scanning, and managing electronic records.
 Prepared electronic patient charts for medical staff by scanning in all documents received via fax,
email, hard copy, etc. into the appropriate medical records file.
 Scheduled and conducted appointments for HEDIS Chart reviews for multiple insurance companies.
 Functioned as the troubleshooter with Vendors to resolve any issues/problems/concerns.
 Prepared outgoing electronic patient correspondence in accordance with HIPAA guidelines.
 Pulled correspondences, labs, results, consult reports, medical records, etc., and electronically
attached the files to the appropriate patient charts.
 Filed all paper charts upon completion of electronic scanning in a manner that allowed
easy methods of retrieving.
 Processed and responded to medical record requests for stored/archived files in a timely manner.
 Carefully reviewed medical records for accuracy and completion as required by insurance
companies.
 Implemented new policies and procedures for handling medical records, while keeping the Medical
Records Department up to date with state and federal regulations.
 Generated patient invoices for records using excel and recorded all the invoices processed on a
spreadsheet.
 Worked with the LEAN Project partnered with BCBSM to develop strategies to create efficient clinic
practices.
 Presented a training based on the LEAN findings to the clinic on new processes and improvements
through the use and creation of PowerPoint slides.
FRONT DESK REPRESENTATIVE MAY 2012 – AUGUST 2013
Western Wayne Family Health Centers – Inkster, MI
 Maintained the receptionist area,including greeting visitors and responding to in-person requests for
information.
 Received patients, answered calls and queries,assisted patients in completing medicalforms, and
collected fees per clinic protocol.
 Registered patients and informed them of the medicalpolicies to be followed, and the services offered
at the facility.
 Scheduled patient appointments.
 Documented and organized patients' records for reference.
 Maintained front office supplies and the records of daily monetarytransactions.
 Completed insurance verification with health-care providers, including Medicaid, Medicare, and PPO
and HMO servicers.
 Processed patient referralrequest.
 Thoroughly investigated past due invoices and helped to minimize the number ofunpaid accounts.

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 Directed patient flow and minimized patient wait time.
 Troubleshot and resolved issues in a quickly manner in a high volume medical call center.
Customer Assistant Representative March 2008 – May 2012
Best Buy - Westland, MI
 Maintained a neat and well-presented store, while replenishing merchandise on a daily basis.
 Answered and directed phone calls to the appropriate departments.
 Built customer rapport through the process of understanding each customer’s own personal needs.
 Drove sales by increasing product sale’s baskets.
 Performed consultations with customers for Geek Squad services.
 Shared product knowledge with customers while making personalrecommendations.
 Demonstrated that customers come first by servingthem with a sense of urgency.