Toni McGehee
Savoy,TX
Summary
Communicative, adaptable, and data-driven professional with 15 + years of experience in insurance and benefits-oriented work. Able to collaborate across various internal and external networks to provide the “extra mile” in service. Benefits Manager with experience includes overseeing and wide range of plans, including retirement, medical, dental, vision, life and disability. Handles company-wide maintenance needs as well as new hire and open enrollment processes. Develops cost-saving initiatives in pension administration.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Medical Claims Biller/Collector
Hunt Regional Healthcare
05.2023 - Current
- Responsible for ensuring proper coding guidelines and procedures are followed when filing medical claims to various patient insurance carriers
- Daily processing of Medicare and Medicaid claims
- Completing active follow-up on delinquent accounts with a focus on 'clean claims' and A/R aging
- Researching and processing rebills, working correspondence, and interpreting payor guidelines
- Responsible for contractual reviews and adjustments when necessary
- Perform reconciliations of payer remits after electronic postings to patient accounts
- Process and complete assigned bills within 48 hours of receipt
- Consistently provide excellent customer service at all times to internal and external patients, physicians, co-workers, and all other customers
- Review HIM (Medical Records) to ensure that all requests are complete before sending out
- Responsible for entering accurate and thorough comments on patient accounts
- Generating claims, AR, appeals, and working denials
- Responsible for following up on correspondence and other mail received within 72 hours of receipt.
Benefits Advisor
Association Member Benefits Advisor
04.2022 - 12.2022
- Supported Member Benefits operations, which included reviewing client information, scheduling appointments, presenting products, and educating clients on benefits selection
- Implemented a consultative approach to selling needs-based products to potential clients by establishing a professional rapport and identifying product-based solutions
- Assessed annual applications by closely reviewing materials, uploading information to vendor platforms, and serving clients with customized solutions
- Assisted customers with claim filing, explanation of Medicare EOB’s, provider excess billing, etc
- Capitalized on opportunities to take advantage of professional development programs to stay updated on changes in laws, regulations, and best practices in the insurance industry
- Reviewed tax-free fund transfers, direct transfers, and direct rollovers for quality and compliance issues, while communicating with clients, agents, financial institutions, and internal departments.
Office Manager/Accounting Administrator
Reel Plumbing & Contracting Inc.
06.2020 - 03.2022
- Analyzed all previous projects to track billing accuracy, completion, and retention releases
- Verified billing accounts with accounts receivable ledgers to ensure that all payments were accounted for and properly posted.
- Managed office administration personnel with a approachable leadership style.
- Managed all aspects of human resources including benefits administration
- Proactively maintained project billing database to ensure company compliance with contractor protocols and requirements.
- Projected financial tracking including change order logs, material purchases, and profit and loss for each project.
- Methodically reconciled bank accounts using QuickBooks.
General Lines Agent
State Farm Mutual Automobile Insurance Company
06.2018 - 05.2020
- Developed 10+ leads a day by identifying market trends, scheduling appointments, and adapting to specific customer needs
- Collected relevant property and automobile information in order to make accurate and appropriate determinations on insurance benefits
- Communicated regularly with 300+ clients to identify needs and account information changes
- Provided high customer service to clients through strong interpersonal skills and effective long-term relationship building.
Senior Engineer Technician
Luminant Oak Grove Power Plant
05.2011 - 10.2016
- Oversaw operations by analyzing credit usage and reconciliations, monitoring machinery, supporting compliance, completing necessary documentation, assisting inspections, and reviewing expenses
- Instrumental in supporting purchasing by contacting suppliers for pricing, lead times, shipping, and setting up new vendors in the system
- Guided 435+ employees in participation initiatives and training—such as OSHA module segments of training—to ensure compliance and attain a 100% completion rate
- Set up MRP data for new parts, creation of routings, creating purchase orders, production order process, and supplier order management using SAP database functions
- Achievements: Migrated parts and equipment from one operating system to another in SAP ERP when the power plant was decommissioned to operating plant
- Worked closely with manufacturers, vendors, and shipping companies to ensure productive and accountable operations.
Engineer Technician II
Luminant Oak Grove Power Plant
09.2006 - 05.2011
- Managed timely documentation of accounts payable, accounts receivable, and accounting reports through effective time management and organization skills
- Completed strategic analysis and forecasting of project budgets valued between $4.3MM - $5.5MM
- Monitored boiler machinery and ensured compliance with safety and regulatory guidelines
- Prioritized workflow and project accountability by examining project completions, inventory, relevant metrics, and forecasts to determine monthly budget accruals
- Supported asset management operations by tracking and documenting data on large equipment and parts using the SAP database.
EVP, Employee Benefits Manager
First American Bank, Texas
06.1993 - 05.2004
- Developed tools to help managers and staff in calculating compensation levels.
- Improved benefits communication, resulting in increased employee understanding and participation.
- Performed evaluations of competitor actions, legislative changes and collective bargaining results in order to make sound decisions about future company benefits and compensation.
- Fostered a culture of continuous improvement by regularly reviewing processes and policies surrounding employee benefits management.
- Evaluated existing pension plans and recommended improvements to ensure long-term financial stability for participants.
- Conducted regular audits of benefit plans to identify discrepancies and maintain accuracy in records.
- Managed relationships with external vendors such as insurers and brokers, fostering strong partnerships in support of company objectives.
- Audited benefit programs and agreements to optimize service delivery.
- Coordinated disability claims management, working closely with insurance providers to facilitate prompt resolutions for affected employees.
- Implemented wellness programs to encourage healthy lifestyles among employees and lower insurance premiums.
- Organized retirement planning workshops, empowering employees to make informed decisions about their financial futures.
- Expedited benefit delivery by establishing working relationships with benefit providers.
- Educated staff on the value of their benefits package through training sessions and informational materials.
- Streamlined benefits enrollment process for smoother onboarding of new employees.
- Oversaw open enrollment processes during Number quarter.
- Ensured compliance with all federal, state, and local regulations governing employee benefits programs.
- Analyzed market trends to ensure competitiveness of company''s benefits offerings in recruitment efforts.
- Kept programs in line with plan structure, company policy and legal requirements.
- Developed customized reports for senior leadership detailing key metrics related to employee benefit program performance.
- Collaborated with HR colleagues to integrate benefits processes into broader human resources strategy.
- Assessed client requirements and developed targeted benefits solutions.
- Evaluated different providers offering range of services, coverages and plan options to pick optimal choice.
- Managed FMLA administration, coordinating leave requests and tracking time off for compliance purposes.
- Assisted employees with resolving complex benefit-related issues, providing timely support and guidance.
- Developed and executed annual open enrollment events, ensuring timely updates to employee benefits elections.
- Created rewards and recognition programs for acknowledging employees' achievements.
- Optimized benefit plan administration by implementing efficient record-keeping systems and processes.
- Educated new hires about different benefit plans.
- Reduced benefits expenses by revamping company plans for dental, life and disability.
- Reduced overall company healthcare costs with strategic negotiations and vendor partnerships.
- Directed and controlled 401K, medical, dental, and vision benefit packages.
- Fulfilled reporting requirements of Employee Retirement Income Security Act (ERISA).
- Demonstrated a high level of initiative and creativity while tackling difficult tasks.
- Paid attention to detail while completing assignments.
- Skilled at working independently and collaboratively in a team environment.
- Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
- Developed and maintained courteous and effective working relationships.
Skills
- Communication
- Account Management
- Compliance
- Leadership
- Organization
- Problem-Solving
- Vendor Relations
- Time Management
- Teamwork
- Microsoft Office Applications
- CERNER
- EZ Pay
- Salesforce
- Kronos
- FIM
- Maximo CMMS
- Five9
- Micro GADS
- SAP ERP
- Athena
- ADP
- HRIS System
- PeopleSoft
- QuickBooks
- Ceridian
- Workday
Accomplishments
- Coordinated open enrollment process for health and welfare plans. Performed vendor management.
- Evaluated insurance programs and strategize with corporate management and broker to find. Monitored vendor performance and cost efficiencies.
- Work closely with HRIS Benefits Analyst to manage and maintain all benefit configuration, reporting, workflow, and vendor file feeds.
Education Certifications
General Lines Agent License [#2361788], Texas Department of Insurance, Expires Sept 2025
Affiliations
1996- 2004 Member of the Brazos Valley SHRM Chapter.
2018 -Current -Texas Department of Insurance
Certification
Life and Health Insurance License,
Texas Department of Insurance
(NIPR #18986457, License 2361788)
Timeline
Medical Claims Biller/Collector
Hunt Regional Healthcare
05.2023 - Current
Benefits Advisor
Association Member Benefits Advisor
04.2022 - 12.2022
Office Manager/Accounting Administrator
Reel Plumbing & Contracting Inc.
06.2020 - 03.2022
General Lines Agent
State Farm Mutual Automobile Insurance Company
06.2018 - 05.2020
Senior Engineer Technician
Luminant Oak Grove Power Plant
05.2011 - 10.2016
Engineer Technician II
Luminant Oak Grove Power Plant
09.2006 - 05.2011
EVP, Employee Benefits Manager
First American Bank, Texas
06.1993 - 05.2004
Life and Health Insurance License,
Texas Department of Insurance
(NIPR #18986457, License 2361788)
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