Janelle Morton
Nashville,TN
Summary
Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Provider Quality Liaison
Centene
06.2021 - Current
- Established, managed, and educated 300 physician’s practices on NCQA HEDIS measures and risk adjustment
- Developed HEDIS educational materials that improved compliance audit outcomes by 75 %
- Experienced in successful start and completion of several HEDIS projects assigned in quality improvement department
- Experienced in participating in audits including successfully researching and completing element narratives
- Assisting in the review of current communication strategies and plans for the organization
- Assists in enhancing quality care for members through care gap identification and closures
- Writing a variety of reports, products, and projects such as fact sheets
- Provides education to providers, staff, and others regarding updates in guidelines/standards, codes, etc
- Proficient in Microsoft Office-Word, Outlook, Excel, and PowerPoint along with various EMRs
- Seen as team player in small cohesive group of quality improvement professionals.
Lead Advanced Medical Support Assistant
Department Of Veteran Affairs
10.2016 - 06.2021
- Assisted in management of patient care and treatment plans, including medication administration, vital sign monitoring, and documentation of all actions taken during shifts
- Monitors and creates work assignments, provides input on performance, resolves daily workplace issues, and maintains efficient workflow
- Develop detailed procedures and guidelines to supplement established administrative regulations or program guidance
- Aids and provides input in problem solving on operational issues or procedures in team meetings and perform administrative follow up actions
- Schedule veteran's using return to clinic orders for 10 providers which consist of mental health, primary care, and clinical pharmacist/nutritionist
- Documented activities related to patient care in accordance with regulatory requirements regarding confidentiality of health information and maintained appropriate records pertaining to each patient's condition throughout their hospitalization or outpatient visit utilizing electronic medical record system software or paper charts depending upon facility policy
- Engaged in strategic planning for company growth
- Collaborated with team members to achieve target results
- Proved successful working within tight deadlines and fast-paced atmosphere.
Managed Care Specialist 3
State of Tennessee
01.2015 - 04.2016
- Case Manager for Medicaid needs of Disabled and Aged Community
- Determined Medicaid eligibility for Caretakers, and Nursing home applicants
- Determined Medicaid supplements for Medicare recipients
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols, and third-party requirements regarding billing
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures, and regulations
- Collaborated with manager to maintain daily operations
- Communicated complex inquiries to internal and external business partners regarding policy guidelines
- Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their polices when applicable.
Service Coordinator
Cognasante
09.2014 - 01.2015
- Initiated contact with appropriate service providers to request referrals and followed up to confirm appointments
- Assisted leadership staff in developing and maintaining specific work procedures, policies, and process improvement projects
- Managed over 50 customer calls per day
- Interviewed Medicaid consumers for eligibility
- Synchronized resources to facilitate case and network management
- Works with County agency and community organizations to coordinate effective service provision to clients; and facilitates development of community partnerships to promote services for eligible clients
- Maintained accurate records and full compliance with government regulations and agency guidelines
- Assisted leadership staff in developing and maintaining specific work procedures, policies, and process improvement projects
- Review all received documents and make eligibility determination in accordance with all rules, regulations, policies, and guidelines
- Provide excellent customer service to both internal and external stakeholders.
Admissions Financial Centralized Coordinator
Vanguard Health Services
03.2014 - 05.2014
- Assisted in patient admission process based on federal and state laws
- Oversaw in-patient and out-patient functions and bed assignments and increased census by 40%
- Prepares admissions reports by collecting, analyzing, and summarizing data and trends
- Confirmed all insurance benefits met standards of admissions as dictated by policy
- Performed document filing, bookkeeping, and faxing for busy student admissions office
- Completed preliminary paperwork for incoming and outgoing patients
- Utilized problem solving and organizational skills to promote process improvement
- Managed volume workload including verification of patient's Medicare and Medicaid
- Obtains applicant information by requesting completed applications and medical information, verifying, and clarifying information, interviewing patients and family members, and explaining admissions criteria
- Organizes patient records and documentation.
Medical Management Specialist II
Amerigroup
03.2012 - 03.2014
- Provided non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers
- Gathers clinical information regarding cases and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review)
- Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits
- Provides general program information to members and providers as requested
- Handled up to 20 calls per day to address customer inquiries and concerns
- Prepares reports and documents all actions
- May review and assist with cases
- Maintains and updates tracking databases
- Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Health Promotion Consultant
Amerigroup
04.2007 - 03.2012
- Partnered with agencies and organizations driving improvements in community health
- Prepared presentations on health and safety concerns for the public
- Provided strategic direction in establishing and implementing national promotion programming initiative through seminars, education programs, classes, and materials in prevention, health behavior modification, and disease management
- Continuously built and refined business relationships and collaborative agreements with various institutions, including community-based organizations, schools, and health departments, regarding community education and outreach programs
- Influenced accountability in spearheading events for community members rendering telephonic outreach support, and monitoring compliance with health plan's contractual and regulatory requirements
- Achieved and surpassed event's quarterly goals by 225% accomplishing approximately 35 to 40 functions companywide
- Trained key members and providers on all aspects of health promotion policies, programs, and services, thus, optimizing productivity
- Contributed to successfully providing 10 to 15 sales presentations monthly, as well as in creating Microsoft Excel spreadsheets which effectively streamlined data collection process
- Refined Marketing Department in determining and executing activities and services which will significantly promote retention and optimize market penetration and growth
- Assisted with development of improved seminars and training materials.
Education
Certification - Professional Medical Coding
Codes Unlimited Healthcare Academy
Memphis, TN10.2023
Master of Science -
Tennessee State University
Nashville, TN12.2009
Bachelor of Science -
Tennessee State University
Nashville, TN08.2005
Skills
- Mentorship and Training
- Microsoft Office
- Cross-Functional Collaboration
- Document Quality
- Accounts Payable and Accounts Receivable
- Maintaining Quality Assurance Standards
- Administrative and Office Support
- Reporting and Analysis
- Total Quality Management
- Professional Development
- Attention to detail
- Policies And Procedures
- Administration
- Quality management
Certification
Yellow Belt, 2017
Timeline
Provider Quality Liaison
Centene
06.2021 - Current
Lead Advanced Medical Support Assistant
Department Of Veteran Affairs
10.2016 - 06.2021
Managed Care Specialist 3
State of Tennessee
01.2015 - 04.2016
Service Coordinator
Cognasante
09.2014 - 01.2015
Admissions Financial Centralized Coordinator
Vanguard Health Services
03.2014 - 05.2014
Medical Management Specialist II
Amerigroup
03.2012 - 03.2014
Health Promotion Consultant
Amerigroup
04.2007 - 03.2012
Certification - Professional Medical Coding
Codes Unlimited Healthcare Academy
Master of Science -
Tennessee State University
Bachelor of Science -
Tennessee State University