Medical Customer Service

TONYA BECKETT-JOHNSON, MA, DHA

**** *********** ***** ( Charlotte, NC ( 678-***-**** (

**********@*****.***

Summary of Qualifications

. Strong background in bridging knowledge of health care administration

with knowledge of human behavior.

. Extensive knowledge of topics related to healthcare trends, healthcare

policy, healthcare economics, healthcare marketing, health benefit

administration, clinical research, and client/project management.

. Crisis Management: Nonviolent Crisis Intervention Certified; CPR

Certified/ Knowledge of First Aid Procedures

. Extensive knowledge of Joint Commission Standards, Accreditation

Commission for Health Care, Managed Care Organizational Polices, and

Emergency Procedures

. Adept at establishing and maintaining a working rapport across various

healthcare disciplines.

. Comfortable in structured and unstructured environments where

initiative and creativity are encouraged.

. Excellent oral and written communication skills and strong focus on

customer service

. Experienced with Microsoft Office products, memo and speech writing,

public speaking, formal presentation preparation, research, data

analysis, publication preparation, event planning, and healthcare

communication.

Education

University of Phoenix-Phoenix, AZ

DHA, Doctor of Health Administration

Graduated 2008

Approved Dissertation: Exploring the Relationship Between Emergency

Department Overcrowding and the Occupational Satisfaction of Staff

Argosy University--Georgia School of Professional Psychology: Atlanta, GA

Graduated 2001

MA, Clinical Psychology

Argosy University--Georgia School of Professional Psychology, Atlanta, GA

Graduated 1999

MA, Counseling Psychology

Clemson University--Clemson, SC Graduated

1997

BA, Psychology with a minor in Sociology

Professional Experience

Hospice & Palliative Care Charlotte Region - Charlotte, NC

2012-Present

Medical Services Manager

. Responsible for oversight and direction of the daily operations of the

Medical Services Department. Provides supervision and evaluation of

team members. Assists with hiring, orientation and mentoring of new

employees. Complies with all expectations of quality improvement

activities to continuously monitor, evaluate and improve team

performance and departmental output.

. Fiscal Management. Generates proposal for annual budget for the

medical services department. Manages the annual budget for the medical

services department. Provides continual auditing and reconciliation of

the departmental billing process. Approves and ensures the accuracy of

all time sheets/payroll summary forms and paid time off requests for

the entire department.

. Continual analysis of departmental productivity. Develop and maintains

departmental score card. Administers monthly evaluation of palliative

medicine services among each contracted long-term care facility. Assists

in the forecasting, planning, evaluating, and setting of objectives for

program services

. Assumes responsibility for the effective administration of team

functions. Stays abreast of current trends in healthcare and ensures

timely incorporation of new information, policies and/or procedures into

practice. Modifies and/or develops new policies and procedures based on

trends and needs. Ensures continuity of patient care during staff

absences.

. Maintains professional relationships with both internal and external

stakeholders. Participates in the coordination and maintenance of

interdepartmental communication as a member of the Leadership Council.

Investigates all consumer concerns filed against the department and

facilitates prompt resolution.

Skyland Trail/ George West Mental Health Foundation--Atlanta, GA

2007-2012

Quality Improvement/Utilization Review/Medical Records Manager

. Conducted chart analysis and completion, to include auditing all newly

admitted clients' records within 14 days of admission, auditing 10% of

all active clients' records, and auditing all discharged clients'

records and notifying staff of deficiencies as necessary. Ensured

compliance with procedures, regulations and standards of the Joint

Commission. Identified problems with documentation and work with

clinicians to develop appropriate solutions.

. Conducted individual tracers intended to follow the course of care,

treatment, and services provided to an individual client, assess

relationships among staff and functions, and evaluate performance of

processes relevant to the individual client.

. Devised Quality Improvement Plan. Utilize Performance/Quality

Improvement processes to develop plans of improvement for identified

problems resulting from audits.

. Quality Improvement member. Team leader of quality improvement project

- Quality Clinical Documentation. Generate monthly report to be

reviewed by the Quality Improvement team.

. Supervised the utilization review and medical record departments.

Managed and evaluated the performance and duties of utilization

specialists and medical record clerks.

. Fiscal Management. Generated proposal for annual budget for the

utilization review/medical record departments. Managed the annual

budget for the utilization review/medical record departments.

. Pursued ad hoc/single-case agreements. If it is determined that

Skyland Trail is a non-participating provider and/or the potential

client has no out-of-network benefits, outreach calls are placed to

appropriate representatives with the Managed Care Organization (MCO)

to pursue an ad hoc/single-case agreement. Coordinate the approval of

the ad hoc/single-case agreement by obtaining a written contract from

the MCO and present contract to the Vice President of Operations for

review and authorization.

. Monitored compliance with Managed Care Organization (MCO) contracts

along with the Skyland Trail Chief Financial Officer (CFO) and

negotiate contractual rates for participating MCO providers.

. Maintained and updated utilization review (UR) records of both paper

and computerized logs of individual client reviews.

. Assisted in the development of policy & procedures. Stayed abreast of

UR trends and updated UR policies and procedures within the

organization.

. Performed ongoing UR. Ensured that concurrent review and extended stay

reviews occur in accordance with MCO's level of care guidelines.

Supported the positions of clients and the treatment team while

fostering positive professional relationship with MCO care managers.

Served as liaison between clients, Skyland Trail treatment teams, and

MCO care manager.

. Coordinated the Peer Review and Complex Case Review process and

prepared and submitted appeals to MCOs.

. Monitored compliance with Health Insurance Portability &

Accountability Act (HIPAA) regulations to include reviewing all

incoming requests for medical records and insuring that all

authorizations are properly completed.

Dekalb Medical Center-Decatur, GA

Clinical Assessment Counselor (PRN)

2006-2011

. Completed accurate and thorough psychiatric assessments for a Level

III Trauma Center.

Assessment Counselor Supervisor

2001-2006

. Supervised counseling staff and evaluated the performance of full-time

and per diem assessment counseling staff.

. Observed, critiqued, and provided constructive feedback to graduate

level student interns to ensure the meeting of clinical practicum

academic requirements, to include education in basic therapeutic

assessment skills, proper administration of a thorough psychiatric

evaluation, and overall performance at the completion of the

assessment rotation.

. Generated proposal for the annual budget for the assessment department

and managed approved budget.

. Monitored Performance Improvement and tracked assessment times and

patient care times for the purposes of benchmarking.

. Educated patients and patients' family on prescribed psychopharmacologic

medications including review of prescribe drugs' onset, outcome, and side

effects, with emphasis on the importance of medication compliance and

avoidance of alteration of medication dosage.

Assessment Counselor

1999-2001

. Completed accurate and thorough psychiatric assessments and evaluated

presenting symptoms associated with mental disorders and chemical

dependency disorders.

. Assessed and discerned patient safety and acuity and determined

appropriate level of care for patients suffering from mental illnesses

and/or chemical dependency and when necessary, initiated the process of

involuntary commitment to ensure the safety of mentally ill and/or

chemically dependent patients.

. Reviewed basic comprehensive laboratory results such as Urinalysis,

Urine Drug Screen, Chem 7, and CBC. With a basic understanding of

inpatient admission requirement for medical stabilization, flagged all

aberrant laboratory results and brought them to the attention of

appropriate medical staff.

. Verified health coverage benefits and eligibility, contacted patients'

managed care organizations to determine eligible coverage, and

completed pre-certification of admission through the provision of

clinical rational, as exhibited by presenting symptoms, for each

individual admission..

. Served as clinical liaison between patients and physicians and emergency

medicine physicians or hospitalists and on-call psychiatrists.

. Collaborated with both public and private mental health facilities

regarding admission of patients when the behavioral health department at

Dekalb Medical Center had no availability or assessed patients required

inpatient admission but were uninsured. Worked closely with the county's

community mental health center to supply proper treatment to non-insured

county residents with mental health services.

Professional References Available Upon Request

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