Ivy Lofton
Orlando,FL
Summary
Driven healthcare professional with extensive experience in case management, compliance, and organizational development. Skilled in HIPAA compliance, FMLA, workers' compensation, and ICD-9/CPT billing. Proven ability to optimize business performance, improve processes, and enhance employee relations. Adept at identifying inefficiencies, implementing solutions, and exceeding organizational goals. Strong expertise in Medicaid, Medicare, and community resource coordination.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Long Term Care Support Specialist
WellCare
03.2020 - Current
- Manage caseloads in compliance with state-mandated ratios, ensuring timely and comprehensive assessments for members utilizing home and community services
- Collaborate with primary care physicians (PCPs), specialists, and integrated care teams (ICT) to develop and implement Person-Centered Care Plans
- Coordinate service authorizations, including meals, transportation, and activities of daily living (ADLs)
- Educate members and families on community resources, emphasizing medical, behavioral, and social services
- Ensure compliance with HIPAA, FMLA, and other federal and state regulations
- Conduct regular follow-ups and monitor member progress to adjust care plans as needed
- Coordination and care management of members with lower utilization of home community services (i.e
- Members attending adult day care services or those who are stable on current medication / treatment regimens)
- Manages an active caseload based on state mandated ratios according to residential setting, case intensity and acuity
- Ensures comprehensive assessments are completed within required time frames and utilizes knowledge and expertise to assess options for care including use of benefits and community resources
- Partners effectively with the PCP, Specialist, member, member’s family and integrated care teams (ICT) to develop a Person-Centered Care Plan
- In partnership with the member, family, physician(s), ICT and other providers, assesses short- and long-term member needs, evaluates the need for alternative services and establishes member driven care management objectives
- Responsible for coordination of service authorizations (i.e
- Meals, transportation, activities of daily living)
- Educates on and coordinates community resources with emphasis on medical, behavioral and social services
- Applies care management standards and maintains HIPAA standards and confidentiality of protected health information
- Ensures compliance with all state and federal regulations and guidelines in day-to-day activities
- Performs special projects as assigned
Project Manager/Lead Waiver Support Coordinator
Bridge Builders of Central Florida
10.2013 - 04.2020
- Oversaw caseloads for individuals with disabilities, ensuring person-centered care and adherence to iBudget Florida guidelines
- Coordinated service authorizations for a wide range of services, including therapies, durable medical equipment, and residential care
- Advocated on behalf of recipients, connecting them with critical community resources to achieve their personal goals
- Audited claims, addressed eligibility issues, and ensured full compliance with Medicaid regulations
- Provided leadership and training for team members on policies, procedures, and best practices
- Ensured recipients' self-direction by creating and implementing personalized care plans that aligned with their long-term needs and goals
- Developed collaborative relationships with primary care physicians (PCP), specialists, family members, and other key stakeholders to design and implement tailored care strategies
- Assessed both short- and long-term needs for alternative services, ensuring alignment with recipients’ care objectives
- Managed and coordinated a variety of service authorizations, including transportation, therapies, skilled nursing, durable medical equipment, and personal support services
- Delivered education on available community resources and integrated medical, behavioral, and social services into care plans
- Maintained strict HIPAA compliance and confidentiality of protected health information while overseeing care coordination and management
- Collaborated with internal and external teams to resolve problems and ensure service delivery for individuals with disabilities
- Worked within iBudget Florida’s individual budgeting system to manage waiver budgets ranging from $10,000 to $204,000
- Coordinated with recipients, service providers, and Waiver Support Coordinators (WSCs) to optimize budget allocations
- Processed budget increase requests based on recipients' changing needs and coordinated service delivery accordingly
- Provided education to clients about the SSD/SSA process, including documentation, forms, and timeframes
- Managed and tracked authorization requests to ensure timely and accurate approvals, working closely with insurance providers to verify eligibility and coverage
- Led efforts to address authorization and claims trends, identifying opportunities for process improvement
- Collaborated with various departments to assign claims projects and ensure efficient resolution of eligibility issues
- Stayed updated on Medicaid Bulletins and regulatory changes, submitting requests for necessary modifications
- Acted as a subject matter expert for the team on complex authorization processes, supporting multiple service types with varying urgency levels
- Maintained proficiency in medical terminology, insurance policies, and authorization procedures
Case Worker
Binder and Binder
11.2012 - 06.2013
- Assisted clients with Social Security Disability (SSD) claims, including form completion, medical record requests, and appeals
- Served as a liaison between clients, attorneys, and the Office of Disability Adjudication and Review (ODAR)
- Maintained accurate and confidential client records in compliance with HIPAA regulations
- Provided exceptional customer service, addressing client inquiries and concerns promptly
Education
Bachelor of Science - Criminal Justice
Florida Agriculture & Mechanical University
12.2007
Skills
- Case Management
- Waiver Program & Care Coordination Knowledge
- HIPAA
- FMLA
- Workers’ Compensation Compliance
- Medicaid/Medicare Regulations
- Billing (ICD-9, CPT)
- Person-Centered Care Planning
- Process Improvement
- Organizational Development
- Team Leadership
- Training
- Claims Auditing
- Eligibility
- Problem-Solving
- Budget Management
- Healthcare Knowledge
- Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Documented and resolved [Issue] which led to [Results].
Certification
- 701B Certificate, Department of Elder Affairs
- Waiver Support Coordinator
- First Aid/CPR/Bloodborne Pathogens
- Alzheimer’s Disease and Dementia Care
- Certified Target Case Manager, Lakeside Behavioral Health, 03/01/12
Languages
English
Full Professional
Timeline
Long Term Care Support Specialist
WellCare
03.2020 - Current
Project Manager/Lead Waiver Support Coordinator
Bridge Builders of Central Florida
10.2013 - 04.2020
Case Worker
Binder and Binder
11.2012 - 06.2013
Bachelor of Science - Criminal Justice
Florida Agriculture & Mechanical University
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