Dr. Melissa Berdell received her Bachelor of Arts in Political Science and a minor in Economics from the University of Pittsburgh. She then received a Master of Science in Administration of Criminal Justice from Point Park University. She attended Duquesne University where she received a Doctor of Healthcare Ethics. While at Duquesne University she was a member of the Golden Key National Honor Society, a resident in Clinical Ethics at UPMC Mercy, and an intern with Value Behavioral Health of Pennsylvania. Dr. Berdell was also a Graduate Research Assistant of Healthcare Ethics while at Duquesne University.
Dr. Berdell is a Certified Fraud Examiner and an Accredited Health Care Fraud Investigator. She has trained in a variety of training engagements as follows:
Gateway Health Plan, Inc., Provider Training
- Presents quarterly trainings to providers that feature payment integrity, compliance, and coding requirements
Pharmacy Fraud Efforts
- Presented at the 2019 Pennsylvania Bureau of Program Integrity Annual Compliance Training for Managed Care Organizations
Beacon Health Options, Massachusetts Provider Compliance Trainings
- Presented monthly trainings to new providers that feature payment integrity, compliance, and coding requirements
Beacon Health Options, Giving Value Back Trainings
- Presented quarterly trainings to new providers that feature fraud, waste, and abuse requirements
Beacon Health Options/Value Options, Inc. Compliance Summit Trainings
- Presented annual on-site trainings for Compliance Directors, Managers, and Auditors
Value Behavioral Health of PA Provider Trainings
- Presented various webinars and in-person training to providers on fraud, waste, and abuse
Importance of Documentation in Healthcare
- Presented at the 2014 Pennsylvania Bureau of Program Integrity Annual Compliance Training for Managed Care Organizations
Building a Successful Compliance Program
- Co-presented at the 2010 National Health Care Compliance Association Managed Care Conference
Dr. Berdell started her career with Alcoa as a Cash Control Accounting Specialist where she designed and conducted self-assessment audits for cash control functions, and she
assisted in both internal and external audits. She then worked for Gateway Health Plan, Inc as an Internal Auditor II.
Dr. Berdell was then recruited by Beacon Heath Options, Inc. as the Director of Compliance and Program Integrity. While at Beacon Health Options, she was then promoted to Director of National Program Integrity, and then became the Assistant Vice President of Payment Integrity, Network Strategy.
Currently, Dr. Berdell is the Director of Fraud, Waste, and Abuse, Payment Integrity at Gateway Health Plan Inc. where she functions as the lead for fraud, waste, and abuse activities and executes the Anti-Fraud Plan for Gateway Health Plan, Inc. She is also responsible for directing progressive audits, investigations, and recovery activities for the Special Investigations Unit. Dr. Berdell also formulates and presents financial forecasting and reporting from payment integrity initiatives and activities. In her capacity as the Director, she designs and maintains data mining and reporting related to patient and provide profiling, outcomes, encounters, and claims billing in accordance with national and state standards.
