LaTonia White - McCreary
Summary
Compassionate Health Care Professional experienced at handling caseloads without sacrificing quality of care in Call Center operations, Member Services, Provider Relations and Care Coordination environments. Hardworking and dedicated to achieving desired outcomes. Offers excellent problem-solving, conflict resolution and communication abilities.
Overview
26
26
years of professional experience
1
1
Certification
Work History
CASE MANAGER ASSISTANT - WOMEN'S HEALTH
TEXAS CHILDREN”S HEALTH PLAN
10.2023 - Current
- Monitored, triaged and routed referrals received via In baskets or CRMs
- Supported case managers and social workers with scheduling appointments for assessments, locating providers, scanning incoming ISPs and reaching out to providers for documents
- Pulled various high risk reports, such as:, First Fill Emergency Room Visit, Admissions Alerts and refer pregnant members to service coordinators or social workers, according to high risk issues
- Updated eligibility for Chip Perinate members for postpartum appointments.
- Received and processed Value-Added Services requested for qualified members
- Created and tracked applications for Value Added Services/Fulfillments and update Operational procedures in SharePoint weekly.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
SENIOR PROVIDER SERVICES REPRESENTATIVE
TEXAS CHILDREN”S HEALTH PLAN
11.2015 - 10.2023
- Assisted with the creation of the initial authorization for healthcare services to gain approval via the health plan
- Followed-up with Providers regarding authorization approvals and educated on any additional documents that may be needed to appeal a denied authorization
- Discussed with providers the availability and accessibility of specialists, and assisted as necessary, and refers issues to appropriate parties
- Assisted and educated providers in questions relating submission of detail for SSI authorizations, content and timeframes necessary for continued stay authorizations
- Transferred calls to assigned intake coordinators relating to authorization issues, questions or capabilities of service providers
- Addressed provider's claims, billing, coordination of benefits, and systems inquiries
- Solved complex issues through extensive research involving multiple program applications and departmental communications
- Served as liaison with other cross-departmental projects with Provider Services and Member Services
- Educated providers on recoupment and offset payments
- Researched and explained claim diagnoses and procedures, edits, eligibility, authorizations, coding and credentialing issues
- Maintained updated knowledge of Medicaid, CHIP, Star Kids and the Healthy Texas Women products and program
- Ensured all insurance companies and governmental entities are posted accurately and in a timely manner using the correct forms, policies and procedures
- Familiar with ICD-10, HCPCS, CPT coding, HCFA 1500 & UB-04
- Escalations Point of contact for diffusing irate callers
- Ensured all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times
- Scheduled various appointments using EPIC software
- Maintained updated knowledge of Medicaid, CHIP, Star Kids and the Healthy Texas Women programs
- Verified Insurance & HIPPA via QNXT, TMHP, and Health Trio
- Documented calls using MACESS service forms
- Assisted with on the job training of new hires for The Center for Children and Women
- Created training material and performed one on one coaching of The Center call center staff on various updates and new developments
- Assisted leadership with grading calls and running monthly reports.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Implemented innovative tools within call center environment which boosted overall productivity of provider services team while maintaining high level of customer satisfaction.
YOUTH/EVENTS/ COMMUNITY SERVICE DIRECTOR
SUNNY SIDE COMMUNITY DEVELOPMENT CENTER
03.2009 - 04.2020
- Facilitated educational programs and sporting events.
- Supervised and assigned the day-to-day activities of as many as 250 or more assigned community service clients and volunteers
- Ensured program activities and services met the program quality standards of Harris County Community Service Restitution Program
- Maintained, prepared and submitted Community Service Restitution reports
- Managed budgets and financial resources for effective allocation of funds towards community projects.
- Established partnerships with local businesses to create employment opportunities for community members in need.
- Increased volunteer participation by creating targeted recruitment campaigns and promoting opportunities through local media outlets.
- Secured grant funding by writing persuasive proposals outlining the benefits of various community projects.
- Spearheaded successful fundraising initiatives, generating necessary resources to support program expansion and growth.
- Championed diversity and inclusion efforts within the organization, cultivating an environment that embraces all perspectives and backgrounds.
- Provided timely reports on project progress, ensuring transparency and accountability within the organization.
- Coordinated large-scale community events to promote awareness of available services and foster civic pride.
- Mentored junior staff members in professional development activities, empowering them to grow into leadership roles within the organization.
- Oversaw staff training and development, ensuring a high level of competence in delivering valuable services to the community.
- Collaborated with local organizations for joint events, strengthening community bonds and resource sharing.
- Enhanced community engagement by developing and implementing various outreach programs.
- Utilized grant writing skills to secure additional program funding.
- Monitored program performance and outcomes for successful delivery of services.
TEAM LEAD/TRAILING DOCUMENT SPECIALIST
STEWART LENDING SERVICES
05.2003 - 11.2008
- Supervised the work of 45 employees to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems
- Reviewed records, and reports pertaining to activities such as production, shipping to verify details, monitored work activities and evaluate performance
- Trained and instructed employees on various work procedures and company policies
- Ordered public record and private documents from third parties and county court facilities
- Verified and examined information and accuracy of loan application and closing documents
- Assembled and compiled documents for loan closings, such as HUDs, Good Faith Estimates, insurance forms, loan forms and tax receipts
- Prepared and audited loan applications, closing documents, legal documents, letter, forms, government notices and checks, using computers
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Trained new team members by relaying information on company procedures and safety requirements.
- Spearheaded multiple high-impact projects simultaneously while meeting tight deadlines under pressure-packed situations.
CLAIMS SUPERVISOR
LITTON LOAN SERVICING
05.1998 - 05.2000
- Supervised seven employees in Claim department
- Processed claims for reimbursement to property damage
- Examined claims forms and other records to determine insurance coverage
- Analyzed information gathered by investigation and report findings and recommendations
- Investigated and assessed damage to property and create or review property damage estimates
- Investigated, evaluated, and settled claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
- Adjusted reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies
- Resolved complex, severe exposure claims, using high service oriented file handling.
Education
Mathematics/Psychology/Education
University of Houston
Houston, TX05.1996
Civil Engineering/Mathematics -
Prairie View A & M University
Prairie View, TX12.1990
Skills
- Program Applications:
- EPIC
- MACESS
- QNXT
- TMHP
- Vital
- CISCO
- EMDEON
- PEMS
- Provider Search Tool
- Well Sky
- Health Trio
- Microsoft Word
- Microsoft Excel
- Microsoft Power Point
- Microsoft Outlook
- Healthy Planet
- Problem-Solving
- Case Management
- Organization and Multitasking
- Documentation And Reporting
- Relationship Building
- Chart Documentation
Certification
Notary Public, Texas, valid until 2025.
Life Insurance License, Texas Insurance Administration, 2025 (#2744274)
Timeline
CASE MANAGER ASSISTANT - WOMEN'S HEALTH
TEXAS CHILDREN”S HEALTH PLAN
10.2023 - Current
SENIOR PROVIDER SERVICES REPRESENTATIVE
TEXAS CHILDREN”S HEALTH PLAN
11.2015 - 10.2023
YOUTH/EVENTS/ COMMUNITY SERVICE DIRECTOR
SUNNY SIDE COMMUNITY DEVELOPMENT CENTER
03.2009 - 04.2020
TEAM LEAD/TRAILING DOCUMENT SPECIALIST
STEWART LENDING SERVICES
05.2003 - 11.2008
CLAIMS SUPERVISOR
LITTON LOAN SERVICING
05.1998 - 05.2000
Mathematics/Psychology/Education
University of Houston
Civil Engineering/Mathematics -
Prairie View A & M University
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