Management Specialist Office Manager

TONI L. WHITLOCK

**** **** ****** **. ** Atlanta GA. 30331 C: 404-***-**** ************@*******.***

Career Summary

Healthcare professional dedicated to public and community relations, staff development and project management. Highly accomplished in building rapport with patients, families and staff, while applying leadership to build relationships outside of the organization to better serve my team as well as organization shareholders.

Core Skills and Certifications

Microsoft Office Utilization Management/Revenue Cycle Procedures Mental Health Process Improvement Budget Management Consultation Resource Allocation Organizational Leadership Time Management Problem-solving Facilitation skills Analytical CARF, HIPAA and OSHA guidelines

Experience

Medical Management Specialist II 07/2019 to Current

Anthem Atlanta, Georgia

Gathers clinical information regarding case and determines appropriate area to refer or assign case. Act as liaison between Medical Management and/or Operations and internal departments.

Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases. Maintain Work Que(s) daily. Refer cases requiring clinical review to appropriate Nurse Reviewer, and managing work flow..

Prepare reports and document all actions Prepare/distribute daily census to HCM/CST teams and other stakeholders.

Request medical records from providers. Tracks referral according to specified timelines and notifies providers and families of eligibility determinations and referrals, prior authorizations and/or deferrals.

Identifies barriers with in department line of business and recommend actions to address operational challenges.

Prepares and communicates information to appropriate parties regarding departmental procedures, and changes.

Train, coach, counsel, and evaluate new hires for department readiness.

Responds to telephone, written, and in-person inquiries and initiates steps to assist regarding issues relating to content or interpretation of clinical and non-clinical client information.

Assists in problem solving with providers, claims or service issues.

Coordinates internal and external resources to meet identified needs of clients.

Perform special project work consistent with the role as dictated by the needs of the business and to identify process improvements measures.

Office Manager 09/2018 to 06/2019

GKH II Fayetteville, Georgia

GKH was a startup business. I led efforts related to budget, staffing, hiring and authoring various policies and procedures related to Medicaid and Medicare licensure. Training and intake for CNA and patients. Ultimately responsible for daily operations, development, implementation, and improvement of organizations policies and procedures.

In charge of program budgets ($250,000+) and costs to verify expenses were within budget parameters.

Provided appropriate staffing to meet the needs of the organization and patient’s demands and for developing cross-training policies and procedures where clinically and administratively appropriate.

Perform on-site and remote chart/records/procedures audits, recommend and implement action plans for improvement. Resolve any medical-administrative problems

Managed practice care relationships, including monitoring of related reimbursement, negotiation with third party payers, provider credentialing, and maintenance of contracts.

Office Manager/Assessment Assistant 03/2016 to 12/2018

Renewing of the Mind Counseling Services, LLC. Conyers, Georgia

Renewing of the Minds also a startup business where I was committed to and led efforts related to budget, staffing, hiring and authoring various policies and procedures related to Commercial, Medicaid and Medicare payer licensure. In charge of organizational operations, client intake, insurance verification, prior authorization for service, chart auditing, and responsible for development, implement and improve organizations policies and procedures.

Implement and maintaining current on CARF, HIPAA and OSHA guidelines to improve client satisfaction.

Maintain centralized database case records identifying client’s history of trauma, strengths, and needs.

Monitored program budgets ($100,000+) and costs to verify expenses were within budget parameters.

Retrieve and obtain authorizations for Medicare and Medicaid claims prior to and during stay. Coordinate billing and payment for clients and apply for Medicaid assistance for indigent payers.

Assign appropriate diagnosis and procedure codes following coding guidelines for ICD-10, CPT-4 and HCPCS codes for all pre-certification requests.

Conduct internal and external audits to assure organization is compliant with all regulatory accreditation

Lead Financial Care Coordinator Specialist/Discharge Planner 08/2014 to 02/2018

WellStar Atlanta Medical Center Atlanta, GA

Lead Financial Care Coordinator Assistant assess and collect client data reported to Revenue Cycle for billing purpose. Assign appropriate diagnosis and procedure codes following coding guidelines for ICD-10, CPT-4 and HCPCS codes for all pre-certification requests

Perform concurrent reviews and chart audits (admission to discharge).

Supervise 15 new and current staff members each year (Direct and Indirect).

Participate in client’s care planning by identifying the social and emotional needs of the residents in accordance with the medical assessment. Make referrals to support agencies when the need for such services is determined by the interdisciplinary team, keeping records of such referrals.

Developed and coordinated individualized discharge plan for the patient by utilizing information obtained from the patient, families, treatment team, and medical record to determine discharge planning needs.

Other Professional Experience

Staffing Coordinator 05/2013 to 08/2014

Delta Homecare Newnan, GA

Group Home Manager 07/2012 to 11/2013

ResCare Homecare - Atlanta – DeKalb Atlanta, GA

Case Management Asst. /Surgical Tech L&D 01/1999 to 06/2009

Tenet South Fulton Med Ctr. East Point, GA

Education and Training

Life Coaching: Certificate of Completion Grand Canyon University, Phoenix, AZ

Master of Science: Psychology Grand Canyon University Phoenix, AZ

Master of Science: Public Administration Grand Canyon University Phoenix, AZ

Bachelor of Science: Psychology Grand Canyon University Phoenix, AZ

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