Manager Medical
Resume:
CAROLYN WALLER
**** ***** ***** ***** *******, Texas 77048
*******************@*****.***
OBJECTIVE
Enthusiastic and innovative advocate who works diligently and effectively to protect the rights of disabled individuals. Passionate about helping people become their own best advocates. Aspire to educate parents, students, community leaders and educators on the laws that seek to preserve the dignity and livelihood of people with disabilities. Eager to learn new things by exploring new ideas in an open and positive manner.
EDUCATION
Texas Southern University Houston, Texas
Masters of Public Administration May 2013
University of Houston Downtown Houston, Texas
Bachelors of Science in Psychology May 2011
SUMMARY
Anticipates client needs prior to requests
Completes scheduled and nonscheduled tasks in a timely manner.
Adapts quickly to unexpected situations
Communicates clearly and effectively
Confronts challenges with optimism and effective problem solving.
Works expeditiously on individual projects as well as in collaboration with others.
EMPLOYMENT HISTORY
Houston Methodist Hospital November 2015- Current
Follow up Account Manager
Conducts comprehensive quality audits to identify system or claim adjudication deficiencies and monitor the effectiveness of claims payment processes and system performance.
Review, revise and research professional billing summaries using IDX healthcare systems. Research, review and resolve commercial and government denials, pended claims appeals processing and timely follow up of customer services inquiries from patients, providers and various insurance carriers.
BCFS June 2016 – Current
Case Manager
Coordinate all referrals, service planning, and documents for assigned cases.
Assess all potential placements
Conduct phone calls, background interviews and home visits within the required timeframes.
Develop individual case plans with particular attention to culture, language, and any special circumstances
Maintain all assigned case files
Provide information, education, referrals, outreach, advocacy, and support to ensure that each child receives required services
Assess the safety and appropriateness of all placements on an ongoing basis utilizing child welfare and social work best practice principles.
Serves as the liaison with stakeholders, including legal providers and Immigration.
Helps identify resources and community supports available to the family
Documents all relevant and appropriate information gathered during the investigation and completing all required forms accurately and in a timely manner.
Texas Department of Protective Services March 2014- October 2015
Case Worker
Provide ongoing services to children in substitute care to meet specific needs by using appreciate resources.
Initiates appropriate legal actions, testify in court
Complete narrative repots on each client.
Investigate reports of abuse/neglect and assessing risks.
Interview children, family members, medical and legal authorities.
Develops and maintains effective working relationships with law enforcement officials, judicial officials, legal resources, medical professionals, and other community resources.
Village of Women February 2009- June 2015
Assistant Director
Launched community events to raise money for college scholarship.
Advised students about future careers and college goals.
Organized college campus tours and career events.
Tutoring for after school program
Seminars on continuing education
Interfaith Texas Inc. August 2010- July 2011
Activity Coordinator
Counseled clients with special needs and helped them in overcoming their concerns.
Generated relief funds for them through public visits and advertisements and through coordination with other community agencies.
Coordinate work programs and computer training
Collaborate with Social Services and charitable organizations to provider free services for the residential community
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