Toni A. Eargle

Assisted Cigna employees with account inquiries in a call center environment. Handled inbound calls to resolve various customer issues while providing exceptional service. Met multiple performance goals, including resolution rates and customer satisfaction levels.

• Managed multiple Health Plan accounts nationwide (600,000+ covered members) consistently exceeding performance guarantees and earning top rating in biannual satisfaction surveys.
• Designed and implement customized solutions for client challenges, including organizing health fairs, biometric screenings and high-level Joint Commission meetings, increasing client retention by 22%.
• Facilitated state and federal audits by ensuring adherence to compliance requirements and providing detailed reporting using Salesforce and MS Office Suite.

• High-profile HealthPlan contract/client in Columbia SC.
• Strong relationships built and maintained with client.
• Heavy case load which required extreme organization, prioritization and quick decision making to resolve issues.
• Trained client and coworkers on multiple data software used in day-to-day management for research and reporting, including Microsoft Office Suite, Cognos, Tableau and RX Track.
• Dissection of root cause for issues along with creating and implementing corrective action plans.

• Built lasting and trusting professional relationships with providers in the Columbia and surrounding Midland’s area within hospital systems and private practices to implement processes and workflow to help providers utilize all tools available to attain 5 STAR ratings. The ratings are based on HEDIS measures, so having a strong knowledge and understanding of these directives ensured success.
• Directed and managing the Medicare Stars quality program for 22 provider groups with over 100 total physicians and UHC membership of over 10,000 covered lives.
• Year after year of improvement with the HEDIS measures of over 55%.
• Experience as a medical practice manager helped build a bridge of trust with provider groups for implementation and process review and change.
• Daily Reviews analyzing and reporting on multiple platforms including Cognos, Tableau and PCOR shared with providers.

• Working manager involved in all daily functions of this multi-specialty practice (infectious diseases and psychiatry, 4 physicians) to include scheduling, triage, check in, check out, payroll, accounts payables and all clinical operations. Responsible for all AR including posting, coding, appeals, prior authorizations and collections. Hiring and training of all staff. Strong prioritization and organizational skills used daily. Extensive research and process adherence for implementing new and experimental medical procedures and coordination with the hospital for multiple providers involving multiple departments.

• Oversee all daily functions of this busy OBGYN practice to include scheduling, triage, check in, check out. Responsible for all AR including posting, coding and collections. Hiring and training of all staff. Surgery scheduling and insurance pre-authorization. Successful daily conflict resolution.

• Human Resource Management which includes administering benefits for a staff of 90 employees. Credentialing of staff for licensure and training, monthly statistical performance, employee satisfaction and benefit financial reporting along with budgeting. Training and orientation of all new staff. Benefit and salary research to keep organization current with national trends. Recruiting of new employees. Conflict resolution with employees as well as administering corrective action plans in alignment with national processes directed by the United Way and in adherence to federal labor laws.

• Oversaw daily operations of two busy front desks(FSC and United Way) and a department of 5 administrative assistants, assuring quality customer service, efficiency and accuracy in all support provided to this non-profit organization with a staff of 65. Responsible for assessing and scheduling of all new clients seeking outpatient mental health counseling services. Additional responsibilities include all health insurance billing, research and payment posting, credentialing of clinical staff, monthly statistical performance, client satisfaction and financial reporting as well as budgeting, accounts receivables and payables.

• Performed daily operational functions of this very busy psychiatric practice with a staff of 9 Licensed Professional Counselors and Licensed Clinical Social Workers. Duties included intake assessment, appointment scheduling, insurance verification and pre-authorization, insurance billing, coding and collections, accounts receivables, credentialing and administrative support for all therapist.

• Oversaw all daily functions of this medical practice with multiple locations. Supervision and training of all staff employees, front and back office. Accounts receivables and payables, daily deposits and bank reconciliation, payroll, employee benefits, insurance billing, coding, appeals and collections. Assisted in organization and creation of fellowship program. Preparation of monthly reports tracking charges, new patient ratios and referral percentages.
• There is a gap in the above employment history from July 2014 through March 2015. I was employed during this time by White Oak Manor Columbia as a Business Office Associate. This position did not align with my career goals as I was exploring other organizations and careers outside of medical practice management.