DEMETRA WILLIAMS
Lawrenceville,GA
Summary
Highly motivated and results-oriented professional with exceptional leadership and communication skills with extensive knowledge who is eager to contribute to the team. . Recognized consistently for performance excellence and contributions to success.
Overview
35
35
years of professional experience
Work History
Parent Mentor Family Engagement
DeKalb County School District
Stone Mountain , GA
03.2017 - Current
- Collaborated with community program leaders and advocates to make resources accessible to those in need withing the Special Education population in the DCSD.
- AId parents and families to assess needs and provide informational resources.
- Built solid and trusting rapport with children and families, fostering trust and communication to meet case needs.
Project Manager
Eternity Inc
Stone Mountain, GA
05.2003 - Current
- Acquisition of property.
- Managed all construction projects for new building.
- Negotiated contracts for all work needed for completion.
- Daily manager of all aspects of business.
- Directed planning, budgeting, vendor selection and quality assurance efforts.
Sr. Digital Customer Service Provisioning Rep
AT&T Communication
Atlanta, GA
06.2001 - 03.2003
- Analyzing components of current system to add, modify or upgrade phone and network system of contracted clients.
- Initial point of contact with the company for the implementation and purchase of needs.
- Worked with telecommunications carriers for ordering, installation, and troubleshooting of voice and data circuits Interfaced with the customer / partner to gather and document complex technical requirements.
- Informed customers of product, price and policy changes to educate on issues and resolve concerns.
- Evaluated customer information to explore issues, develop potential solutions and maintain high-quality service.
Precertification Specialist/Managed Care Specialist
Emory University Healthcare/ The Emory Clinic
Atlanta, GA
01.1999 - 08.2001
- Fulfilled all precertification requirements prior to procedures, surgical admission and medical admissions Coordinate care prior to admission with physicians and/or RN's at insurance precertification agency Proficient in all aspects of the managed care industry to include vast knowledge in HMO, PPO, POS and all their requirements Working Knowledge of Specialty Networks; Horizontal and Vertical Network Obtained Specialty Referrals Provide Clinical Information to appropriate parties to obtain authorization for inpatient surgeries and any outpatient surgical procedures Responsible for coding of these surgical procedures.
- Coordinated with section coder for maximum reimbursement.
- CPT Codes/ ICD-9 ( ICD-10) codes Obtained authorization for admission for surgery per Capitated Network.
- Knowledge of M&R Guidelines.
- Knowledge of clinical protocol for authorizations Working knowledge of all managed care forms required for authorization Knowledge of Medicaid Pre-certification and Prior Approval Guidelines Verified eligibility and benefits and fulfilled all requirements to ensure maximum payment Working knowledge through experience with all major insurance carriers Maintained maximum reimbursements from all insurance carriers and worker's compensation carriers.
- Authorization for multiple physicians with multiple specialties On the initial team establishing this department along with the administration by compiling and analyzing data and identifying areas of improvement.
- Trained new staff on pre-certification procedures.
Utilization Management Coordinator
Cost Care, Inc./State Health Benefit Plan
Marietta, GA
01.1993 - 01.1999
- Initiated pre-certification process for contracted clients Obtained demographics, diagnosis and proposed treatment Responsible for insurance plan explanation for patients/clients Referral maintenance.
- Authorized additional visits as designated from PCP Contacted Utilization Review and/or Physicians office for additional clinical information/Continued Stay Review Data Entry/Medical Intake Case Management letter maintenance Human Resources Support/ Familiar with Benefits Package.
- Documented patient information obtained from phone interviews.
- Kept physical files and digitized records organized for easy updating and retrieval by authorized team members.
Education
University of Georgia
Athens, GAGeorgia State University
Atlanta, GASkills
- Insurance
- Benefits
- Healthcare
- Exceptional Education
- Precertification
- Troubleshooting
- Family services
- Team management
- Project organization
- Telecommunications
- Community Resources
- Supervision
- Process improvement
Timeline
Parent Mentor Family Engagement
DeKalb County School District
03.2017 - Current
Project Manager
Eternity Inc
05.2003 - Current
Sr. Digital Customer Service Provisioning Rep
AT&T Communication
06.2001 - 03.2003
Precertification Specialist/Managed Care Specialist
Emory University Healthcare/ The Emory Clinic
01.1999 - 08.2001
Utilization Management Coordinator
Cost Care, Inc./State Health Benefit Plan
01.1993 - 01.1999
University of Georgia
Georgia State University