Open to opportunities

Marcelle N

@marcellen

Message

Versatile healthcare professional with expertise in clinical operations.

United States

Message

What I'm looking for

I am looking for a role that fosters collaboration, innovation, and growth in healthcare operations.

I am a versatile healthcare professional with over 8 years of progressive experience in clinical operations, project management, and revenue cycle management. My career has been defined by my ability to drive product lifecycle management and innovate solutions that meet customer needs, ensuring profitability in healthcare settings.

Throughout my career, I have excelled in collaborating across diverse teams, analyzing market trends, and implementing user-centric strategies to enhance product performance and client satisfaction. My expertise in regulatory compliance and data-driven decision-making has allowed me to align healthcare operations with organizational goals effectively.

Experience

Work history, roles, and key accomplishments

Current

Revenue Cycle Supervisor

Current

University of Maryland Medical System

Nov 2021 - Present (3 years 7 months)

Oversee reimbursement strategies for high-cost oncology and specialty drugs, ensuring timely payer reimbursements and optimizing billing processes. Lead prior authorization workflows and analyze reimbursement trends to enhance efficiency and patient access to therapies.

Reimbursement Strategies Claims Management Regulatory Compliance Cross Functional Collaboration Healthcare Operations Data Analysis

Appeals Manager

Inova Health Systems

Feb 2020 - Oct 2021 (1 year 8 months)

Managed appeals and grievance processes, ensuring compliance with Medicare and Medicaid regulations. Provided clinical expertise for high-risk patient groups and collaborated with teams to enhance operational efficiency and member experience.

Appeals Regulatory Compliance Cross Functional Collaboration Patient Care Coordination

Insurance Reimbursement Supervisor

First Step House

Jul 2015 - Jan 2020 (4 years 6 months)

Led insurance reimbursement processes and managed a team of specialists to optimize claim submissions. Implemented process improvements to increase reimbursement rates and reduce claim denials.

Team Leadership Process Improvement Compliance

Prior Authorizations Specialist

Apria Healthcare

Mar 2013 - Jul 2015 (2 years 4 months)

Reviewed and processed prior authorization requests for medical services, ensuring compliance with insurance guidelines. Collaborated with healthcare providers to gather necessary information and maintain accurate records.

Compliance Communication Skills