Microsoft office
Shani McGee
Quality/Compliance
Arlington,Virginia
Summary
To pursue a career that offers advancement and opportunities with an establish organization.
Overview
19
19
years of professional experience
4
4
years of post-secondary education
24
24
Certifications
Work History
Medical Field Reviewer-(Contractor)
Change HealthCare
Maryland/Virginia
02.2022 - 02.2023
- Reviewed 'report cards' for Health Plans to ensure the quality of care and services to patients/members, Review Payment Integrity Audits (PIA) to ensure Health Plans are billed correctly through the Centers for Medicare Medicaid, Travel to medical facilities or provider offices in specified areas to complete review services, Communicate with care provider offices, clinics, hospitals, other clinical facilities, Manage paper medical records or an EMR/EHR platform to retrieve information, Healthcare Effectiveness Data Information Sets (HEDIS), Scan relevant components of the medical record to support reviews performed, Upload extracted medical records, Maintain quality and production standards required in accordance with company policy, Comply with HIPAA laws and regulations (PHI/PII)
Provider Education Coordinator(Contractor)
(DHCF) Department of Long-Term Care Administration
Washington, DC
09.2023 - 12.2023
- Lead development and implementation education and training for providers, Completed assessments of provider-driven training education programs, Identify, integrate, and monitoring of existing activities and strategies to offer training and education to LTSS providers
- Performed independent research and analysis of provider training and education issues, challenges, promising practices, and opportunities
- Make recommendations regarding findings and/or implementation of new strategies Assisted in the development and coordination of collaborations with other District agencies to link distinct training and education programs effectively in support of existing and new providers
- Communicated findings and recommendations, both written and oral, to promote constructive change
- Collaboration with management and establishing timely, appropriate action plans and follow-up
- Routinely monitored pertinent policies, laws, and regulatory requirements to ensure compliance with external regulations.
SIS Assessor II (Contract)
Telligen
Northern, VA
05.2023 - 08.2023
- Complete face-to-face assessments of individuals with intellectual and developmental disabilities, Complete SIS training programs including observations, guided practices, classroom work and Interviewer Reliability and Qualification Review Assessments, Comply with all applicable regulations and requirements (HIPAA, Medicaid, etc.), Record data in SIS online databases, Understand and be able to explain SIS results, Attend and participate in regular SIS team meetings
Virginia Quality Service Reviewer-Rehired/Contract
Health Services Advisory Group
Annandale, Va
04.2023 - 08.2023
- Reviewed documentation and maintain caseloads for ID/DD waiver supports, Conduct interviews with Support Coordinators, Guardians, Providers, ID/DD persons, Conduct virtual and onsite individual service plan reviews for assessments of the ISPs requirements and intent of the Centers for Medicare and Medicaid Services (CMS) Home and Community Based Services (HCBS) Settings Final Rule and the Virginia Department of Justice (DOJ) Settlement Agreement (SA)
- Conduct face-to-face interviews regarding the implementation of the individual service plan for assessments of the implementation on the HCBS Settings Rule and the Virginia DOJ SA
- Reviewed the results of provider licensure surveys, complaint investigations, and compliance reviews conducted by the Medicaid agency, Human Rights Committee, and other local/federal agencies, Reviewed documentation on HCBS settings rule for the DOJ/DBHDS, Filed confidential reports with DBHDS/DOJ, Maintained HIPPA files with completed reviews
Quality Certification Surveyor
Qlarant-(Sub-Contractor)
Washington, D.C.
01.2022 - 03.2023
- Evaluate compliance of Home and Community Based Waiver service provision, provider utilization of waiver services, and provider compliance with waiver rules, Conduct interviews with individuals with intellectual and/or developmental disabilities (IDD) and evaluates provider organizational outcomes, Conduct detailed evaluations of provider performance and the presence of person-centered supports using applicable tools and guidelines, Initiate contact with service providers to establish interview and review schedules and discuss associated protocols, expectations, and responsibilities, Conduct interviews with individuals with I/DD, family members, providers of services and/or direct service staff, Administer and makes determination based upon the information gathered from individual, Uses professional judgment and discretion to determine when a report of abuse, neglect and/or exploitation is warranted or a referral to state staff is necessary to maintain the health and safety of individuals receiving services through the Medicaid Waiver program, Report suspected case of abuse, neglect and/or exploitation to required officials and follow established protocols as a mandated reporter, Input data into a web-based application, summarize findings, generate recommendations for quality improvement and complete a written report for submission to the provider/support coordinator/contractor or other entity in accordance with pre-established timeframes
Advocate (Special Needs Trust Program)
The Arc of Northern Virginia
Fairfax, Virginia
08.2021 - 02.2022
- Liaison for Special Needs Trust & families of people with disabilities, Oversee & manage long-term & short-term services and supports, Ensuring that human rights are being implemented with choices, Maintain records and information about the Trust, Review documentation for accuracy and new information, Conduct meetings with family and other Trust team members
Virginia Quality Service Reviewer-DBHDS(Contractor
Health Services Advisory Group
Annandale, Va
06.2020 - 06.2021
- Reviewed documentation and maintain caseloads for ID/DD waiver supports, Conduct interviews with Support Coordinators, Guardians, Providers, ID/DD persons, Conduct virtual and onsite individual service plan reviews for assessments of the ISPs requirements and intent of the Centers for Medicare and Medicaid Services (CMS) Home and Community Based Services (HCBS) Settings Final Rule and the Virginia Department of Justice (DOJ) Settlement Agreement (SA)
- Conduct face-to-face interviews regarding the implementation of the individual service plan for assessments of the implementation on the HCBS Settings Rule and the Virginia DOJ SA
- Review the results of provider licensure surveys, complaint investigations, and compliance reviews conducted by the Medicaid agency, Human Rights Committee, and other local/federal agencies, Review documentation on HCBS settings rule for the DOJ/DBHDS, File confidential reports with DBHDS/DOJ, Maintain HIPPA files with completed reviews
Program Manager /Compliance Administrator
Community Systems Inc.
Fairfax, Va
09.2017 - 05.2020
- Maintain and Advocate changes in annual and monthly budget, Supervise operations and staff, Provide support to residents on concerns, issues and feedback for quality assurance, Provide quality assurance checks on documentation, files, etc., Perform day-to-day decisions on all matters related to operations, Communicate to Directors on budget, maintenance, rep payees/vendors, Support persons with ID/DD with accessing federal and state funds, Rep-payee and Accounts Manager for ID/DD (private banks & ABLE Accounts) federal and state funding, Support with re-instatements of Medicaid/Medicare funding, Review and update rental agreements and changes, Maintain files on state and federal tax information, Usage of federal and state funding for income based needs/support, Report to federal and state agencies annual usage of budget/accounts, Provide written documentation for outstanding bills/accounts, Advocate for people with DD/ID, Conduct person supported investigations, Remain certified with APS mandating reporting trainings, Human Rights Trainer-monthly/as needed trainings to new/current staff members, Conduct HVAC, fire, safety, and emergency quality assurance checks, Maintain vehicle checks and local DMV updates on company vehicle, Review accuracy of resident information including resident account setup, File, maintain records, and conduct daily, weekly and annual documentation, Provide staff supervision and meetings (bi-weekly)
Program Plan Developer/Compliance Manager
St. John’s Community Services
Annandale, VA
08.2015 - 10.2017
- Conduct home inspections (HVAC, State /Federal Licensure, Fire Safety), Document/Complete Monthly reports (inspections, budget, funding, planning), Monitor budgeting and funding, Review documentation for compliance, Participate in regulatory audits/ reviews (DMAS/DBHDS), Assist in budget preparation, Supervise staff and provide leadership to increase morale, Conduct/Provide company wide trainings, Maintain and update company records for compliance
Residential Support Specialist
St. John’s Community Services
Annandale, VA
08.2015 - 09.2017
- Provide In-Home services to adults with intellectual and developmental disabilities, Complete daily progress notes in Therap Database and quarterly person centered reviews, Support with person centered outcomes and goals as outlined in the individual service plan, Attend annually ISP/budgeting/funding meetings and conduct admission/ intake assessments
Vocational Rehabilitation Specialist
ServiceSource, Inc
Alexandria, VA
10.2014 - 10.2016
- Develop, write and implement person centered program plans
- Maintain familiarity with Medicaid, CARF, NISH, and funding source regulations to ensure ongoing compliance with such regulations
- Maintain company records for compliance (CARF, DMAS, DBHDS), Participate in company audits, Conduct investigations for person's with ID/DD, Plan and implement intakes, assessments, and annual reviews of program individuals and their designated funding source, Input and review data in CHRIS, Ultipro, IDOLS, Halogen, and other electronic consumer databases, Provide individual and group crisis intervention, counseling, and rehabilitation, Instructed Community Awareness, Career Development, Health and Safety, and Computer Resource classes
Residential Program Manager
All People Matter
Upper Marlboro, MD
04.2008 - 09.2008
- Supervise, train, and lead employees in a team setting serving youth with intellectual and developmental disabilities, Provide quality assurance and improvement measures to ensure program is in compliance with funding sources, Medicaid, and CARF standards, Conduct staffing trainings, performance evaluation, and scheduled program activities, Conducts individualize support meetings to ensure outcomes and goals are person centered, Monitor/Implement annual budget, Budget Review Board Member, Process payments (rent, utilities, bills), Conduct home inspections
Lead Day Treatment Case Manager
Family Transitions, Inc
Richmond, VA
10.2004 - 04.2008
- Conduct IEP and FAPT meetings for youth with mental illness and substance abuse, Document and maintain accurate reports using BIRP methods with state regulations, Conduct observations and monitoring of youth in educational environment, Conduct team meetings provide guidance and team support to new hires on DSM IV Diagnoses, Supervise the drug and substance abuse policies and test for youth offenders
Education
Human and Health Services B.S. -
The University of Arizona Global(Formerly Ashford University)
01.2014 - 01.2018
Skills
Records review
Compliance knowledge
Auditing processes
Document review
Investigations skills
Policy analysis
Federal and state regulations
Fraud investigation
Performance review
Policy Regulations(Washington DC/Virginia)
Appeals processing
Report preparation
Certification
Centers For Medicaid Medicare LTC- Certification
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Collaborated with team of 4 in the development of program compliance and quality reviews.
- Supervised team of 10 staff members.
- Achieved organizational and tracking by introducing Micro Soft List for tracking, trending, and training updates tasks.
- Documented and resolved compliance issues which led to re-certification for providers and stakeholder.
- Achieved tracking and trending by completing monthly and quarterly reviews with accuracy and efficiency.
Software
Sharepoint
EHR
Outlook
Timeline
Provider Education Coordinator(Contractor)
(DHCF) Department of Long-Term Care Administration
09.2023 - 12.2023
SIS Assessor II (Contract)
Telligen
05.2023 - 08.2023
Virginia Quality Service Reviewer-Rehired/Contract
Health Services Advisory Group
04.2023 - 08.2023
Medical Field Reviewer-(Contractor)
Change HealthCare
02.2022 - 02.2023
Quality Certification Surveyor
Qlarant-(Sub-Contractor)
01.2022 - 03.2023
Advocate (Special Needs Trust Program)
The Arc of Northern Virginia
08.2021 - 02.2022
Virginia Quality Service Reviewer-DBHDS(Contractor
Health Services Advisory Group
06.2020 - 06.2021
Program Manager /Compliance Administrator
Community Systems Inc.
09.2017 - 05.2020
Program Plan Developer/Compliance Manager
St. John’s Community Services
08.2015 - 10.2017
Residential Support Specialist
St. John’s Community Services
08.2015 - 09.2017
Vocational Rehabilitation Specialist
ServiceSource, Inc
10.2014 - 10.2016
Human and Health Services B.S. -
The University of Arizona Global(Formerly Ashford University)
01.2014 - 01.2018
Residential Program Manager
All People Matter
04.2008 - 09.2008
Lead Day Treatment Case Manager
Family Transitions, Inc
10.2004 - 04.2008