Microsoft office/EMR
Melissa Herron
Social Services
Freeport,IL
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
14
14
years of professional experience
Work History
CARE MANAGEMENT COORDINATOR
Aetna Better Health Illinois
02.2023 - Current
- Manage sixty plus members, arrange transportation and documented details of discharge transition plans
- Coordinate referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients
- Interpret regulations to identify patient care requirement criteria to be monitored and establish systems to achieve NCQA compliance
- Communicate with patients and family members to assist with information, provide literature and direct to community resources
- Establish and maintain effective communication with staff, physicians, and community organizations to promote high quality patient care
- Communicate with patients, ensuring that medical information is kept private
- Consult with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care
- Discuss medical histories with members in effort to provide most effective social service advice
- Create customized care plans, working with hospital staff and families to assess and meet individual needs
- Maintain accurate documentation in Dynamo while using QNXT for verification of claims.
IRIS CONSULTANT
TMG
08.2021 - 02.2023
- Assisting with developing customized plans to achieve participant goals in the community related, but not limited to employment, housing, health, safety, transportation, and day programming
- Partnering with participants, APOA's and or guardians in obtaining resources to achieve participant related goals
- Educating participants regarding their monthly budget usage
- Documentation in WISITS, EMR within 48 hours
- Follow the compliance regulations set forth by The Wisconsin Department of Human Services
- Use critical thinking, problem solving and time management skills
- Respond/document critical incidents that may jeopardize the health and safety of participants
- Assist in creating interventions to prevent reoccurrences
- Maintain HIPAA and Compliance regulations
- Use critical thinking skills to break down problems, evaluate solutions and assist the participants in making their own decisions
- Documenting using the EMR-WISITS.
CARE MANAGER
My Choice Family Care
01.2020 - 07.2021
- Completed psychosocial assessments for thirty plus members.
- Developed Member Centered Plans with the member and Registered Nurse to achieve member related goals
- Documented and brainstormed solutions to critical incidents to prevent reoccurrences
- Encourage members, APOA's, Guardians and supported decision makers to play an active role in maintaining the members independence within the community
- Demonstrated excellent customer service skills by having everyone included in the decision making of care
- Coordinated and authorized services that aligned with the member's goals of achievement in the most effective/cost effective way
- Provided community resources to members, APOA's, Guardian's and Supported Decision Makers that were not available within the Family Care benefit package
- As part of the interdisciplinary team, worked on updating goals included in the Member Centered Plan on a continuous basis
- Demonstrating excellent customer service and Care Management skills, maintained continuous contact with members, Guardian's and POA's to ensure safety, and needs are met in a timely manner
- Maintained appropriate, accurate and up to date documentation per Wisconsin Department of Health and Human Services standards
- In collaboration with the Registered Nurse, coordinated and attend care plan meetings, staff meetings and utilization review meetings
- Maintain HIPAA standards, while working with EMR Midas application and collateral contacts
- Consulted with supervisors to assess plans for members and plan strategies for enhancing care
- Coordinated referrals to specialists
- Coordinated with Social Workers, MD's and RNs for discharge planning with hospitalizations, ER visits and rehabilitation centers for a smooth transition back into the community
- Coordinated insurance benefits to obtain durable medical equipment and supplies from approved vendors working with Medicare and Medicaid
- Arranged transportation, medical appointments and followed up on such
- Was a mentor to newly hired Care Managers by training, providing supervision, ongoing staff development and continuing education to employees
- Worked with the EMR system-Midas/Gateway.
HUMAN SERVICE WORKER
Milwaukee County Aging and Disability Resource
05.2018 - 10.2019
- Maintained HIPAA standards, while working in the EMR application Midas and the community with a case load of forty plus persons.
- Completed Long Term Care Functional Screens to determine eligibility for the different Long Term Care Programs, using Gateway
- Conducted enrollment, did-enrollment, and switching of programs
- Counseling
- Assisted consumers with resources within the community
- Adhered to strict client confidentiality laws and site-specific procedures to uphold privacy and provide the best experience possible
- Established positive relationships with consumers, guardians, APOA's and assessed goals, working hard to address individual needs and tailor services to suit them
- Kept and established comprehensive case files to support proper documentation and records
- Acted as mandatory reporter of abuse
- Described procedures, requirements and benefits to customers, guardians and APOA's
- Interviewed consumers for services and assisted with application completion
- Prepared documents for review and completion by consumers, guardians and APOA's and submitting the documentation
- Demonstrated excellent customer service skills and kept families and consumer in the loop throughout the whole process
- Conducted visits to consumers in homes and attended group meetings to provide information on agency services, requirements and procedures
- Documented using EMR-Midas.
LEAD CARE MANAGER
My Choice Family Care DBA Metro CMU
03.2016 - 05.2018
- Completed psychosocial assessments for forty plus persons.
- Developed Member Centered Plans with the member and Registered Nurse to achieve member related goals
- Documented and brainstormed solutions to critical incidents to prevent reoccurrences
- Encourage members, APOA's, Guardians and supported decision makers to play an active role in maintaining the members independence within the community
- Demonstrated excellent customer service skills by having everyone included in the decision making of care
- Coordinated and authorized services that aligned with the member's goals of achievement in the most effective/cost effective way
- Provided community resources to members, APOA's, Guardian's and Supported Decision Makers that were not available within the Family Care benefit package
- As part of the interdisciplinary team, worked on updating goals included in the Member Centered Plan on a continuous basis
- Demonstrating excellent customer service and Care Management skills, maintained continuous contact with members, Guardian's and POA's to ensure safety, and needs are met in a timely manner
- Maintained appropriate, accurate and up to date documentation per Wisconsin Department of Health and Human Services standards
- In collaboration with the Registered Nurse, coordinated and attend care plan meetings, staff meetings and utilization review meetings
- Maintain HIPAA standards, while working with EMR Midas application and collateral contacts
- Consulted with supervisors to assess plans for members and plan strategies for enhancing care
- Coordinated referrals to specialists
- Coordinated with Social Workers, MD's and RNs for discharge planning with hospitalizations, ER visits and rehabilitation centers for a smooth transition back into the community
- Coordinated insurance benefits to obtain durable medical equipment and supplies from approved vendors working with Medicare and Medicaid
- Arranged transportation, attended medical appointments, provided transportation, scheduled medical appointments and followed up on such
- Was a mentor to newly hired Care Managers by training, providing supervision, ongoing staff development and continuing education to employees
- Ensured members were functionally eligible as a Long-Term Care Functional Screener
- Also ensured to maintain credentials as a screener every two years
- Conducted audits of EMR charts to ensure accuracy per Wisconsin Department of Health and Human Services standards.
MEDICAL ASSISTANT
Columbia St. Mary's/Allied Health Group
12.2015 - 03.2016
- Ensured the timeliness of patient care
- Ensured the effectiveness of patient care
- Ensured medical records were accurate, and complete for each patient.
- Sanitized, restocked and organized exam rooms and medical equipment
- Obtained client medical history, medication information, symptoms and allergies
- Directed patients to exam rooms, fielded questions and prepared for physician examinations
- Collected and documented patient medical information such as blood pressure and weight
- Performed clerical duties, such as word processing, data entry, answering phones and filing
- Documented vital signs and health history for patients in clinic and hospital environments
- Called and faxed pharmacies to submit prescriptions and refills
- Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed
- Assisted with routine checks and diagnostic testing by collecting and processing specimens
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted
- Taught patients about medications, procedures and care plan instructions
- Completed clinical procedures and gathered patient data for interpretation by physician
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment
- Obtained pre- and post-treatment vital signs and weight
- Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs
- Tested and recorded blood glucose levels
- Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes.
- Enhanced clinic efficiency by assisting physicians with routine procedures and diagnostic tests.
MEDICAL ASSISTANT/REFERRAL AUTHORIZATION SPECIALIST
Madison Medical Affiliates
2014 - 2015
- Ensured protocols were followed when authorizing procedures
- Worked with insurance companies to obtain prior authorizations for procedures.
MEDICAL ASSISTANT/PATIENT COMPANION
ProHealth Care
09.2013 - 12.2015
- Sanitized, restocked and organized exam rooms and medical equipment after each patient
- Obtained client medical history, medication information, symptoms and allergies
- Directed patients to exam rooms, fielded questions and prepared for physician examinations
- Collected and documented patient medical information such as blood pressure and weight
- Performed clerical duties, such as word processing, data entry, answering phones and filing
- Documented vital signs and health history for patients in clinic and hospital environments
- Called and faxed pharmacies to submit prescriptions and refills
- Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed
- Assisted with routine checks and diagnostic testing by collecting and processing specimens
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted
- Taught patients about medications, procedures and care plan instructions
- Completed clinical procedures and gathered patient data for interpretation by physician
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment
- Obtained pre- and post-treatment vital signs and weight
- Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing
- Tested and recorded blood glucose levels
- Prepared initial patient charts for admission
- Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes
- Verified appropriate lab couriers picked up collected lab specimens
- Obtained all prescribed laboratory testing
- Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.
CAREGIVER
Home Instead Senior Care
08.2012 - 12.2013
- Entertained, conversed with, or read aloud to patients to keep them mentally healthy and alert for 3 clients.
- Assisted with dressing guidance, grooming, meal preparation and medication reminders
- Assisted clients with daily living needs to maintain self-esteem and general wellness
- Built strong relationships with clients to deliver emotional support and companionship
- Cleaned house, ran errands, managed laundry and completed weekly grocery shopping
- Engaged patients in meaningful conversation, socialization and activity while providing personal care assistance
- Maintained clean personal areas and prepared healthy meals to support client nutritional needs
- Assisted patients with self-administered medications
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives
- Supported clients with mental support and physical activities to accomplish quality of life and sustain needs
- Provided safe mobility support to help patients move around personal and public spaces
- Planned healthy meals, purchased ingredients and cooked meals to provide adequate nutrition for client wellbeing
- Documented residents' mental status, sleep and eating patterns in medical record books
- Helped patients care for themselves by teaching proper, safe use of ambulation assistive devices such as canes or walkers
- Entertained, conversed and read aloud to keep patients mentally alert
- Maintained frequent supervision of residents unable to call for assistance.
VOLUNTEER
Milwaukee Rescue Mission
06.2014 - 08.2014
- Maintained clean, neat and operational facilities to serve program needs
- Volunteered with groups and organizations to help make measurable differences for program recipients.
MEDICAL ASSISTANT
Aurora Health care
08.2009 - 08.2012
- Sanitized, restocked and organized exam rooms and medical equipment after each patient.
- Obtained client medical history, medication information, symptoms and allergies
- Directed patients to exam rooms, fielded questions and prepared for physician examinations
- Collected and documented patient medical information such as blood pressure and weight
- Performed clerical duties, such as word processing, data entry, answering phones and filing
- Documented vital signs and health history for patients in clinic and hospital environments
- Called and faxed pharmacies to submit prescriptions and refills
- Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed
- Assisted with routine checks and diagnostic testing by collecting and processing specimens
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted
- Taught patients about medications, procedures and care plan instructions
- Completed clinical procedures and gathered patient data for interpretation by physician
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment
- Obtained pre- and post-treatment vital signs and weight
- Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing
- Tested and recorded blood glucose levels
- Prepared initial patient charts for admission
- Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes
- Verified appropriate lab couriers picked up collected lab specimens
- Obtained all prescribed laboratory testing
- Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus
- Ordered and prepared reagents and supplies
- Arranged surgeries with surgical center, confirming times with patients and preparing admission and consent forms
- Ambulated, turned and positioned patients
- Compiled necessary documents for surgical billing packages
- Maintained accurate documentation in the following EMR systems: Cerner, GE and Epic.
Education
Bachelor of Science - Human Services Management
Cardinal Stritch University
Milwaukee 11.2015
Diploma - Medical Assisting
Sanford-Brown College
Milwaukee07.2007
Skills
- HIPAA Compliance
- Interpersonal Skills
- Effective Communication
- Resource Coordination
- Trauma Informed Care Framework
- Psychosocial Assessments Expert
- Insurance understanding
- Multitasking
- Adaptability
- Stress management
- Organizational skills
- Conflict Resolution
- Microsoft Office Suite
- Team Collaboration
- Medicaid Wisconsin and Illinois Knowledge
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Part TimeFull TimeWork Location
RemoteImportant To Me
Work-life balanceHealthcare benefitsCompany Culture401k matchPaid time off4-day work weekPaid sick leaveFlexible work hoursWork from home optionSoftware
Timeline
CARE MANAGEMENT COORDINATOR
Aetna Better Health Illinois
02.2023 - Current
IRIS CONSULTANT
TMG
08.2021 - 02.2023
CARE MANAGER
My Choice Family Care
01.2020 - 07.2021
HUMAN SERVICE WORKER
Milwaukee County Aging and Disability Resource
05.2018 - 10.2019
LEAD CARE MANAGER
My Choice Family Care DBA Metro CMU
03.2016 - 05.2018
MEDICAL ASSISTANT
Columbia St. Mary's/Allied Health Group
12.2015 - 03.2016
VOLUNTEER
Milwaukee Rescue Mission
06.2014 - 08.2014
MEDICAL ASSISTANT/PATIENT COMPANION
ProHealth Care
09.2013 - 12.2015
CAREGIVER
Home Instead Senior Care
08.2012 - 12.2013
MEDICAL ASSISTANT
Aurora Health care
08.2009 - 08.2012
MEDICAL ASSISTANT/REFERRAL AUTHORIZATION SPECIALIST
Madison Medical Affiliates
2014 - 2015
Bachelor of Science - Human Services Management
Cardinal Stritch University
Diploma - Medical Assisting
Sanford-Brown College
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