Barbara McCarthy
Wynantskill,New York
Summary
Highly skilled and enthusiastic professional with more than 30 years of experience serving Adults and Children with mental health issues. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
My niche appears to be assisting in launching new programs. . Offering engaging and pleasant personality with expertise improving customer relationships.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Director of Managed Care Services/ 29I Liaison
Vanderheyden Hall, Voluntary Foster Care Agency
2019.02 - Current
- Set up and maintenance of electronic health record.
- Liaison to Managed Care organizations contracting and billing.
- Monitor to ensure all individuals are enrolled in Managed Care Insurance
- Complete billing for CFTSS and 29I- scrubbing claims before batched for posting /resolve any denied claims.
- Contracting with Managed Care Organizations
- Batching weekly/monthly billing invoices
- Run monthly eligibility checks.
- Maintain billing rates for all Managed Care Organizations
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Generate monthly cost center report for the following programs: CFTSS/CMHRS, Child and Adult HCBSW, 29 I: Other health related services.
- Progress note review/ reports sent out to clinicians for corrections.
- Input of information into AWARDS per billing rules
- Review/correction of denied claims resulting from human error.
- Monthly meeting with Healthy Alliance partnership
- Regional stakeholder meetings with each MCO
- Quarterly Children’s advisory committee meetings
- Statewide Implementation meetings
- Foothold quarterly meetings
- Quarterly children’s coalition meetings
- Quarterly OCFS meetings regarding 29 I
- Increased company revenue by streamlining processes and implementing cost-saving measures.
- Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
- Boosted client satisfaction rates through exceptional relationship management and prompt resolution of issues.
Operations Manager
Children's Health Home of the Capital District
2015.10 - 2019.02
- Assist with the implementation of NYS Department of Health Children’s Health Home Program
- Recruitment and On-Boarding of 13 Care Management Agencies in the Capital District, as well as ongoing supervision and technical assistance
- Collaborations with Albany Medical Center Hospital, St Peter’s Health Partners, Capital District Psychiatric Center, Capital Care Physicians Network, Whitney M Young and other area hospitals, physician’s and clinics to a build Provider Network.
- Sub-Committee member with Albany County Department of Mental Health, Rensselaer County Department of Mental Health, Schenectady County Coalition for a Healthy Community, NYS Office of Children and Family Services, HEART Program and Regional Planning Consortium
- Collaborate with Managed Care Organizations: CDPHP, Fidelis, Wellcare, United Healthcare of New York, MVP, New York State Catholic Health Plan, Inc.
- Enhanced customer satisfaction by establishing clear communication channels and addressing concerns promptly.
- Developed strong relationships with vendors, resulting in better pricing and improved service quality.
- Achieved higher employee retention rates by fostering a positive work environment and providing opportunities for professional growth.
- Led successful change initiatives, ensuring seamless transitions during organizational restructuring efforts.
- Supervised operations staff and kept employees compliant with company policies and procedures.
Regional Resource Development Specialist
Sunnyview Rehabilitation Hospital/ New York State Dept. of Health
2004.10 - Sep2012
- Assist with the development and implementation of the New York State Department of Health TBI Medicaid Waiver Program and the Nursing Home Transition and Diversion Program throughout a six County Region
- Responsible for approving Individual Service plans and Medicaid reimbursed services detailed in that plan.
- Responsible for an Aggregate Medicaid budget, keeping the daily cost below the current Nursing Home daily rate.
- Responsible for the Quality review of all Individual Service plans assuring they meet State and Federal requirements.
- Tracking and monitoring all Serious Incident reports and identifying agency or individual trends
- Responsible for provider recruitment and application
- Supervised a staff of eight.
- Spearheaded successful special events, including planning, logistics, marketing, and volunteer coordination for maximum impact.
- Pre-screened resumes prior to sending to corporate hiring managers for consideration.
- Developed and implemented onboarding and orientation programs for new employees.
- Collaborated with managers to identify and address employee relations issues.
- Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency.
Care Manager
Center for Disability Services
1993.03 - 1995.03
- Care Management for a case load of 30 children with Developmental Disabilities.
Education
Associates degree in Early Childhood Education -
Dean College
01.1980
Skills
- MS PowerPoint
- MS Word
- MS Excel
- MS Outlook
- Medicaid Analytical Performance Portal
- GSI Health
- NetSmart
- EPACES
- UAS
- Business Planning
- Contract Negotiation
- Project Coordination
- Staff Management
- Contract Management
- Creativity and Innovation
- Partnerships and Alliances
- Data Management
- Operations Management
Certification
- Child and Adolescent Strengths and Needs Assessment
- Bridges out of Poverty
- Motivational Interviewing
- Mental Health First Aid (Suicide Prevention Task Force)
- ACES (Adverse Childhood Experience)
- HIPPA
- Mandated Reporter
- Engagement and Outreach
- Trauma Informed Care
- Person Centered Planning
- Cultural Competency
- LGBTQ Issues – serving transgender children/adolescents and working with Lesbian/Gay/Bisexual/Transgender/Questioning Families
Timeline
Director of Managed Care Services/ 29I Liaison
Vanderheyden Hall, Voluntary Foster Care Agency
2019.02 - Current
Operations Manager
Children's Health Home of the Capital District
2015.10 - 2019.02
Regional Resource Development Specialist
Sunnyview Rehabilitation Hospital/ New York State Dept. of Health
2004.10 - Sep2012
Care Manager
Center for Disability Services
1993.03 - 1995.03
Associates degree in Early Childhood Education -
Dean College
- Child and Adolescent Strengths and Needs Assessment
- Bridges out of Poverty
- Motivational Interviewing
- Mental Health First Aid (Suicide Prevention Task Force)
- ACES (Adverse Childhood Experience)
- HIPPA
- Mandated Reporter
- Engagement and Outreach
- Trauma Informed Care
- Person Centered Planning
- Cultural Competency
- LGBTQ Issues – serving transgender children/adolescents and working with Lesbian/Gay/Bisexual/Transgender/Questioning Families
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