Toni McGehee

• Managed clearance process for patient records, ensuring compliance with regulatory standards.
• Developed and implemented efficient tracking systems for sensitive information management.
• Collaborated with cross-functional teams to enhance communication and streamline clearance workflows.
• Mentored junior staff on best practices for data handling and clearance protocols.
• Facilitated background checks and security clearances for new hires, ensuring compliance with regulatory standards.
• Analyzed documentation to assess eligibility for various clearance levels, maintaining accuracy in processing.
• Developed processes to streamline clearance requests, reducing turnaround times significantly.
• Led training sessions for staff on clearance procedures, enhancing team knowledge and efficiency.

• Accurately code podiatric procedures using ICD-10-CM, CPT, and HCPCS codes, including modifiers for office, outpatient surgery, and inpatient settings.
• Handle billing for various service types, including office visits, surgical procedures, and specialty treatments.
• Obtain prior authorizations and coverage verification through various commercial provider systems, CMS.gov, Availity, Navitas, etc.
• Review system-generated billing, collections, and medical record abstracting reports to ensure accuracy.
• Assist in auditing medical records to verify completeness and accuracy of documentation before billing.
• Communicate with patients about payment deadlines, billing questions, and insurance coverage.
• Ensure compliance with Medicare, Medicaid, commercial insurance, and all applicable federal and state laws.
• Preparing and submitting specifically Medicare, Medicare Advantage, and Medicare Secondary Payer (MSP) claims on CMS-1500 claim forms for processing.
• Researching, correcting, and resubmitting denied Medicare and commercial carrier claims.
• Working directly with physicians to ensure correct ICD10, CPT, and specifically HCPCS Level II codes are accurate when billing claims.
• Proficiency with electronic health records (EHR) and billing software.
• Strong attention to detail, organizational skills, and ability to multitask.
• Managed billing cycles and ensured timely invoicing for international partners.
• Reviewed and reconciled accounts to maintain accuracy in financial records.
• Implemented process improvements to enhance billing efficiency and reduce errors.
• Trained new staff on billing procedures and best practices for accuracy.
• Analyzed billing data to identify trends and support strategic decision-making.
• Developed comprehensive reporting mechanisms to track billing performance metrics.
• Led cross-functional teams in addressing complex billing issues and implementing solutions.
• Researched and resolved billing discrepancies to enable accurate billing.
• Identified, researched, and resolved billing variances to maintain system accuracy and currency.
• Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
• Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
• Collaborated with the collections team to recover overdue payments from clients, maintaining cash flow and minimizing writeoffs.
• Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
• Reduced errors in financial records by conducting regular audits of billed accounts.
• Contributed to improved financial reporting by reconciling discrepancies between invoiced amounts and actual payments received.
• Enhanced customer satisfaction with timely and accurate invoice generation.
• Maximized revenue potential by identifying and resolving under-billed accounts.
• Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
• Facilitated staff training on new billing software, enhancing team productivity and billing accuracy.
• Fostered strong relationships with healthcare providers and insurance representatives to facilitate efficient resolution of billing issues.
• Optimized payment collection times by implementing effective follow-up strategies with clients.
• Improved customer satisfaction with prompt and clear communication regarding their billing inquiries.
• Collaborated with the healthcare team to ensure billing codes were accurately applied, optimizing reimbursement from insurance companies.
• Streamlined billing process efficiency by implementing an updated billing system.
• Identified opportunities for process improvement, leading to a more streamlined billing operation.
• Developed a user-friendly billing guide for patients, improving their understanding and satisfaction with the billing process.
• Reduced billing errors, leading to decrease in customer complaints, by conducting regular audits of billing data.
• Proactively addressed potential billing discrepancies by conducting pre-billing audits.
• Assisted in transition to electronic billing, reducing paper waste and improving operational efficiency.
• Managed monthly billing cycles to ensure timely issuance of invoices and statements.
• Played key role in annual audit process by providing comprehensive billing records and explanations for variances.
• Maintained up-to-date knowledge of billing regulations and compliance requirements, ensuring adherence to legal standards.
• Enhanced interdepartmental communication to ensure accuracy and completeness of billing information.
• Negotiated with insurance companies to resolve disputed claims, securing rightful payments.
• Increased revenue retention by setting up a follow-up system for outstanding payments.
• Contributed to a positive work environment by offering support and guidance to junior billing staff.
• Implemented cost-saving measures by identifying and eliminating inefficiencies in the billing process.
• Enhanced accuracy in patient billing through meticulous record-keeping and verification of insurance details.
• Responded to customer concerns and questions on daily basis.
• Used data entry skills to accurately document and input statements.
• Handled account payments and provided information regarding outstanding balances.
• Collaborated with customers to resolve disputes.
• Processed payment via telephone and in person with a focus on accuracy and efficiency.
• Audited and corrected billing and posting documents for accuracy.
• Monitored outstanding invoices and performed collections duties.
• Maintained accurate records of customer payments.
• Utilized various software programs to process customer payments.
• Generated monthly billing and posting reports for management review.
• Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
• Entered invoices requiring payment and disbursed amounts via check, electronic transfer, or bank draft.
• Reconciled accounts receivable to general ledger.
• Created improved filing system to maintain secure client data.
• Kept vendor files accurate and up-to-date to expedite payment processing.
• Processed vendor and supplier payments on a weekly basis.
• Processed vendor and supplier payments on a weekly basis.
• Encoded and canceled checks using bank machines.
• Coordinated communication with clients regarding billing inquiries and discrepancies.

Family leave

• Auditing a variety of internal documents, procedures, and reports using standard protocols.
• Coordinating efforts between the Internal Audit department and other areas within the organization when needed.
• Working closely with management teams across multiple departments to evaluate current processes against best practices.
• Identifying potential risks associated with operations and providing recommendations for process improvements.
• Utilizing various software tools such as Microsoft Excel and Access for data mining purposes.
• Performing detailed analysis of internal control systems to identify weaknesses and recommend corrective actions.
• Reviewing contractors' compliance with contracts and other regulatory requirements.
• Maintaining a working knowledge of Generally Accepted Accounting Principles standards as well as Sarbanes-Oxley Act requirements.
• Drafting well-written audit reports and other communications to foster accurate interpretation.
• Conducting follow-up activity on issues reported by audit and external parties.
• Led audits to ensure compliance with county financial regulations.
• Developed audit plans enhancing operational efficiency and risk management.
• Implemented process improvements resulting in increased accuracy of financial reports.
• Analyzed financial data to identify discrepancies and recommend corrective actions.
• Collaborated with departments to streamline audit processes and enhance efficiency.
• Presented audit findings to senior management, influencing strategic decisions.
• Conducted risk assessments to prioritize audit activities effectively.
• Performed internal audits of financial and departmental operations, developing risk assessments and conducting process walkthroughs for compliance with documented processes.
• Identified and reported audit issues.
• Contributed to a positive work environment by collaborating effectively with colleagues across all levels of the organization.
• Investigated discrepancies discovered during auditing process.
• Produced audit reports.
• Supported management in developing action plans to address identified issues, promoting timely resolution of audit findings.
• Prepared and distributed risk and audit reports to appropriate personnel.
• Enhanced internal control systems by conducting thorough risk assessments and implementing effective audit recommendations.
• Documented recommendations to improve internal controls.
• Provided valuable insights to management by presenting clear and concise audit findings, contributing to informed decision-making processes.
• Explained risk and compliance concepts to managers and executives.
• Improved operational efficiency by identifying and addressing financial discrepancies through meticulous examination of financial records.
• Reviewed and identified risks, analyzed controls and tested compliance.
• Conducted training sessions for staff members on best practices in internal auditing, fostering a culture of continuous improvement.
• Prepared audit programs and documentation in alignment with Generally Accepted Auditing Standards (GAAS).
• Evaluated compliance with regulatory requirements, mitigating potential risks and protecting organizational reputation.
• Assisted in the development of company policies and procedures, promoting a strong internal control environment.
• Collaborated with cross-functional teams to design and execute comprehensive audit plans, ensuring alignment with company objectives.
• Reviewed financial statements for adherence to International Financial Reporting Standards (IFRS) and corporate regulations.
• Ensured adherence to international audit standards by keeping abreast of changes and implementing necessary updates in audit procedures.
• Facilitated knowledge sharing, creating a comprehensive internal audit manual for ongoing reference.
• Learned and adapted quickly to new technology and software applications.
• Demonstrated strong organizational and time management skills while managing multiple projects.
• Cultivated interpersonal skills by building positive relationships with others.
• Demonstrated a high level of initiative and creativity while tackling difficult tasks.

• Performed quality assurance reviews on completed appeal files before submission.
• Utilized strong problem-solving skills to analyze complex situations quickly and accurately.
• Interpreted provider contracts and reimbursement policies to identify payment discrepancies.
• Maintained an organized system of tracking appeals cases from receipt through completion.
• Ensured accurate documentation of all activities associated with each case file.
• Clear, concise understanding of Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
• Worked directly with physicians and hospital system’s billing departments to ensure correct ICD10, CPT, and specifically HCPCS Level II codes are accurate when billing and appealing claims.
• Collaborated with physicians and hospital system’s billing department to resolve denied claims in a timely manner.
• Composed clear and concise letters summarizing the appeal process, findings, and recommendations for resolution.
• Evaluated multiple sources of information such as medical policy documents and evidence-based guidelines to support appeal decisions.
• Prepared and submitted Medicare, Medicare Advantage and Medicare Secondary Payer (MSP) claims on CMS-1500 and UB-04 claim forms for processing.
• Appealed denied claims through coding review, contract review, medical record review and carrier interaction.
• Prioritized and processed large volume of denials and maintained high quality of work.
• Coordinated and managed appeals for members with complex health care needs, utilizing excellent customer service skills.
• Reviewed and analyzed patient appeals to ensure compliance with hospital policies and regulations.
• Collaborated with clinical teams to gather necessary documentation for appeal submissions.
• Developed training materials for staff on effective appeal processes and best practices.
• Streamlined workflows to enhance efficiency in processing appeals and reducing response times.
• Led cross-departmental meetings to address complex cases and improve collaborative strategies.
• Mentored junior staff on case management systems and effective communication techniques.
• Improved the appeals success rate by researching legal precedents and staying up-to-date with current industry regulations and guidelines.

Pursuing independent learning

• Evaluated multiple sources of information such as medical policy documents and evidence-based guidelines to support appeal decisions.
• Prepared and submitted Medicare, Medicare Advantage and Medicare Secondary Payer (MSP) claims on CMS-1500 and UB-04 claim forms for processing.
• Appealed denied claims through coding review, contract review, medical record review and carrier interaction.
• Consistently used ICD10, CPT and HCPCS Level II codes required by Medicare to ensure claims were billed out accurately.
• Obtained prior authorizations and coverage verification through various commercial provider systems, CMS.gov, Availity, Novitas, etc.
• Reviewed medical records for completeness and accuracy, ensuring they were properly documented, and corrected any discrepancies.
• Was responsible for protecting patient privacy by ensuring records were released only to authorized individuals by strictly following legal and ethical standards.
• Worked directly with physicians and the hospital system’s billing departments to ensure correct ICD10, CPT, and specifically HCPCS Level II codes are accurate when billing and appealing claims.
• Acted as a liaison between healthcare providers and billing offices.
• Analyzed healthcare data to identify trends and improve patient outcomes.
• Developed reports for management to support strategic decision-making processes.
• Increased efficiency by streamlining data analysis processes and implementing automation tools.
• Analyzed healthcare data to identify trends and support decision-making processes.
• Developed comprehensive reports to enhance operational efficiency and resource allocation.
• Collaborated with cross-functional teams to implement strategic initiatives across departments.
• Streamlined reporting processes, improving accuracy and reducing turnaround time for analyses.

• Managed day-to-day operations of the office, such as ordering supplies, processing payroll and managing calendars.
• Resolved customer inquiries and complaints with timeliness and professionalism. Delivered quality customer service to staff and customers.
• Purchased office supplies and equipment to replenish inventory.
• Created and maintained filing systems to ensure accurate record keeping.
• Utilized excellent organizational skills to prioritize tasks effectively.
• Managed weekly timecards for a team of 12 plumbers. Checked that technicians correctly recorded their regular time, travel time, overtime and on-call hours.
• Processed the bi-weekly payroll, using Quickbooks, from start to finish. Entered hours into payroll software, calculated gross pay, and ensured correct tax deductions.
• Compared timesheets with daily work orders to correct errors. Spoke directly with field plumbers to answer their pay questions and resolve questions and discrepancies.
• Maintained neat, organized employee records. Handled, tax forms to include W-4’s and tracked vacation and sick time.
• Ensured timekeeping and pay rules followed state and federal laws to keep company in compliance.
• Managed daily office operations, ensuring efficient workflow and communication among staff.
• Implemented scheduling systems for field personnel, optimizing resource allocation and project timelines.
• Completed bi-weekly payroll for 12 employees.
• Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping.
• Oversaw payroll processing, maintaining compliance with federal and state regulations.
• Coordinated annual budget preparation, aligning departmental expenses with organizational goals.
• Processed bank deposits and reconciled financial statements.
• Contributed to the successful completion of tax filings, collaborating closely with tax consultants to provide necessary documentation and support.

• Utilized problem-solving abilities to troubleshoot customer issues promptly and professionally.
• Provided excellent customer service, demonstrating strong communication and interpersonal skills.
• Managed weekly timecards for five employees.
• Built positive relationships with customers through consistent follow-up communications.
• Successfully handled escalated calls with patience and understanding.
• Cultivated and maintained strong relationships with clients and colleagues to promote customer loyalty.

• I got married in September 2016. Due to a company buyout, Luminant was experiencing a large staff layoff. I chose the layoff option. I put my home on the market for sale. I was able to help my youngest daughter settle into college. I relocated to Northeast Texas with my husband. All of this took about 18 months. Therefore, I was unemployed for 18 months.

• Reviewed project plans and provided feedback for cost savings or optimization.
• Generated reports and presented progress at meetings, achieving goals within budget.
• Managed operations, ensuring compliance and efficiency across a team of 435+ employees.
• Facilitated vendor relations, optimizing procurement processes and reducing lead times.
• Implemented SAP ERP migrations, enhancing system integration and operational continuity.
• Analyzed credit usage and expenses to optimize budget allocations, enhancing financial accuracy and reducing unnecessary costs.
• Maintained rigorous documentation and compliance checks, ensuring 100% adherence to regulations and facilitating successful inspections.
• Oversaw compliance with safety regulations and industry standards, promoting a culture of safety within the plant.
• Managed project timelines and budgets for engineering initiatives, ensuring successful delivery of objectives on schedule.
• Monitored employee performance to keep projects on task.
• Delivered high-quality products by collaborating closely with sales teams to understand customer needs and translate them into viable solutions.
• Enforced rules and regulations to keep working environment safe.
• Controlled project costs by approving expenditures.
• Tracked certain parts of the plant monthly expense for the budget. Project costs tracking, budget accruals and reporting.