Tomeka Allen
Hyattsville,MD
Summary
Dynamic Utilization Management Coordinator at CareFirst with a proven track record in optimizing resource allocation and ensuring HIPAA compliance. Adept at critical thinking and documentation accuracy, I excel in interdisciplinary collaboration to enhance patient care and service delivery. Committed to achieving excellence in healthcare management and client support.
Highly skilled and enthusiastic professional with more than Number years of experience managing operations in patient-centric medical offices. Successfully oversee human resources, budgeting, supply management and patient services. Develop and lead productive and efficient office staff. Contribute to high-volume medical practices by providing exceptional customer service.
Overview
9
9
years of professional experience
Work History
Utilization Management Coordinator
CareFirst
05.2024 - 02.2025
- Collaborated with multidisciplinary teams to develop individualized care plans for patients.
- Actively participated in interdisciplinary team meetings to provide input on patient care, discharge planning, and resource utilization.
- Optimized resource allocation by tracking data trends and making recommendations for improvements in service delivery.
- Maintained accurate documentation of all reviews, appeals, and decisions in line with organizational standards and requirements.
- Supported cost-effective use of services by ensuring that authorization requests met clinical review criteria before approving them.
- Assisted in the development of policies and procedures, ensuring compliance with state regulations and accreditation standards for utilization management practices.
- Ensured regulatory compliance by staying updated on industry guidelines and applying them to daily tasks and assessments.
Eligibility Coordinator
DECO Recovery Management
02.2019 - 03.2020
- Implemented quality control measures that improved accuracy in the eligibility determination process.
- Collaborated with interdisciplinary teams to create comprehensive support plans for eligible clients.
- Analyzed data trends related to client demographics and program utilization rates, providing valuable insights for program improvements.
- Maintained up-to-date knowledge of federal, state, and local regulations to ensure accurate eligibility determination.
- Conducted thorough reviews of documentation to establish clients'' eligibility for various assistance programs.
- Managed caseloads effectively through regular follow-ups and prompt communication with clients, ensuring their needs were met throughout the process.
Human Services Specialist
Athena Consulting LLC
05.2021 - 01.2024
- Processed applications and followed strict procedures to keep sensitive data confidential.
- Met with clients to conduct assessments of current situations and establish what needs to address.
- Maintained accurate case documentation, ensuring compliance with regulatory requirements and agency policies.
- Provided crisis intervention services, deescalating tense situations and connecting individuals to appropriate support systems.
- Understood and recognized signs of physical and substance abuse patterns and other debilitating circumstances.
- Adhered to strict client confidentiality laws and site-specific procedures to uphold privacy and provide best experience possible.
- Maintained heavy caseload of approximately Number cases by utilizing effective time management and organizational skills.
- Participated in trainings and seminars to improve skills set and knowledge.
Paraprofessional
Insight Global
04.2020 - 04.2021
- Oversaw students in classroom and common areas to monitor, enforce rules, and support lead teacher.
- Improved classroom management by assisting teachers with behavioral interventions and monitoring student progress.
- Supervised students during non-instructional periods such as lunch, recess, or field trips, ensuring safety at all times.
- Fostered a positive learning environment by establishing strong rapport with students, parents, and faculty members.
- Kept classrooms clean, neat, and properly sanitized for student health and classroom efficiency.
- Supported school initiatives by participating in professional development opportunities and collaborating with colleagues on best practices for student growth and achievement.
- Assisted classroom teacher in supervising snack time and indoor and outdoor play.
- Reported on student progress, behavior, and social skills to parents.
- Monitored students on field trips, handling roll call, and group movement to keep youths safe in public settings.
- Coordinated with teachers to monitor student progress, identifying areas for improvement.
- Assisted in organization of school events, contributing to vibrant school culture.
- Monitored student safety during school outings, ensuring secure learning environment.
- Provided feedback to teachers on student progress, aiding in adjustment of teaching strategies.
- Supported teachers in grading assignments, ensuring timely feedback for students.
Administrative Assistant
Team Placement Service
06.2016 - 06.2018
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Maintained inventory of office supplies and placed orders.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Assisted coworkers and staff members with special tasks on daily basis.
- Managed filing system, entered data and completed other clerical tasks.
Education
Associate Of Applied Science - Health Care Management
Ultimate Medical Academy
Clearwater, FL06.2021
Diploma - Administrative
Applied Career Training
Arlington VA09.2005
High School Diploma - N\A
Fairmont Heights
Fairmont Heights MD05.1991
Skills
- Multitasking efficiency
- HIPAA compliance awareness
- Critical thinking
- Documentation accuracy
- Medical terminology
- Electronic health records navigation
- Decision-making capacity
- Teamwork
- Customer service
- Attention to detail
- Time management
- Reliability
- Organizational skills
- HIPAA guidelines
- Insurance verification
Timeline
Utilization Management Coordinator
CareFirst
05.2024 - 02.2025
Human Services Specialist
Athena Consulting LLC
05.2021 - 01.2024
Paraprofessional
Insight Global
04.2020 - 04.2021
Eligibility Coordinator
DECO Recovery Management
02.2019 - 03.2020
Administrative Assistant
Team Placement Service
06.2016 - 06.2018
Associate Of Applied Science - Health Care Management
Ultimate Medical Academy
Diploma - Administrative
Applied Career Training
High School Diploma - N\A
Fairmont Heights
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