Melanie N. Downes

A highly organized and detailed orientated individual with 20+ years of professional healthcare experience, who is committed to providing exceptional service. My acquired skills from the respective fields of social services, public health in conjunction with my current graduate studies in Employment Law/Employee Relations has facilitated my capability to work in almost any given environment. My career goals involve a role in which I am tasked with the responsibility of implementing and maintaining organizational policies along with the upholding of federal and state laws/regulations within my scope of practice.

Authorization Specialist - Woodland Anesthesiology Associates (Contracted w/Trinity Health)

(2026-03 - 2026-05)

• Insurance authorization and verification
• Scheduling/Appointments
• Procedure coordination
• Medical records request/release
• Use of multiple insurance websites (Availity, Carelon, Evicore, Cigna, United Healthcare)
• Front desk check-in/check-out
• Updating Electronic Medical Records
• Knowledge of standard office equipment (fax, scanner, copier, printer)
• Knowledge of ICD-10 and CPT codes for billing
• Obtaining consents and signatures for legal documents
• Interview and screen Inpatient/Outpatient patients for financial assistance programs
• Obtain Financial Assistance applications and supporting documentation for processing
• Referrals to Medicaid Vendors for all Self-Pay accounts
• Patient education regarding insurance benefits and cost of treatment
• Collect Out-of Pocket costs (Deductibles/Co-pay/Coinsurances/Balances Due)

Financial Counselor - Trinity Health (SFH)

(2005-01 - 2008-12)

• Insurance authorization and verification
• Scheduling/Appointments
• Procedure coordination
• Medical records request/release
• Use of multiple insurance websites (Availity, Carelon, Evicore, Cigna, United Healthcare)
• Front desk check-in/check-out
• Updating Electronic Medical Records
• Knowledge of standard office equipment (fax, scanner, copier, printer)
• Knowledge of ICD-10 and CPT codes for billing
• Obtaining consents and signatures for legal documents
• Interview and screen Inpatient/Outpatient patients for financial assistance programs
• Obtain Financial Assistance applications and supporting documentation for processing
• Referrals to Medicaid Vendors for all Self-Pay accounts
• Patient education regarding insurance benefits and cost of treatment
• Collect Out-of Pocket costs (Deductibles/Co-pay/Coinsurances/Balances Due)

Financial Counselor - Trinity Health (SFH)

(2025-11 - 2026-03)

• Insurance authorization and verification
• Scheduling/Appointments
• Procedure coordination
• Medical records request/release
• Use of multiple insurance websites (Availity, Carelon, Evicore, Cigna, United Healthcare)
• Front desk check-in/check-out
• Updating Electronic Medical Records
• Knowledge of standard office equipment (fax, scanner, copier, printer)
• Knowledge of ICD-10 and CPT codes for billing
• Obtaining consents and signatures for legal documents
• Interview and screen Inpatient/Outpatient patients for financial assistance programs
• Obtain Financial Assistance applications and supporting documentation for processing
• Referrals to Medicaid Vendors for all Self-Pay accounts
• Patient education regarding insurance benefits and cost of treatment
• Collect Out-of Pocket costs (Deductibles/Co-pay/Coinsurances/Balances Due)

Financial Counselor/Region Intake Specialist - Hartford Healthcare - Hartford, CT

(2013-01 - 2025-09)

• Interviewed patients to obtain/confirm demographic information
• Ensured the accuracy of all required/obtained paperwork
• Corresponded/coordinated with clinical team members/Home Health Agencies/Providers
• Utilized multiple lines of communication (TEAMS, Email, Phone, Fax)
• Conducted online safety checks prior to home health services
• Used multiple insurance websites to verify patient eligibility and benefits
• Waystar/Onesource, United Healthcare, Medicaid
• KRONOS (Timekeeping)
• Updated Electronic Medical Records (EPIC and Home Base Home Care)

Patient Access Rep/ ED Admissions Specialist - State of Connecticut-UCONN Health - Farmington, CT

(2015-02 - 2025-06)

• Insurance notification of Inpatient/Outpatient Admissions
• Prior authorizations/Retro-Authorizations/Registration
• Data Collection/Registration interviews to gather patient demographic information
• Investigation and resolution of denied claims & registration errors
• Knowledge of Insurance plans, benefits and member eligibility
• Customer Service & Data Entry
• Independently creates step-by step manuals used for task completion
• Knowledge of standard office equipment (fax, scanner, copier, printer)
• Knowledge of ICD-10 and CPT codes for billing
• Obtaining consents and signatures
• Collect Co-pays
• Use of insurance payer websites for insurance verification and authorization
• Word, Excel, Power Point, TEAMS

Master of Science - Employment Law - Nova Southeastern University (In progress)

Bachelor of Science - Public Health with a minor in Biology - Southern Connecticut State University (2023-05)

Associate of Science Degree - Social-Services - Capital Community College (2011-05)