Tonnette Henderson
Bartlett,TN
Summary
Experience provider relation manager who is an accomplished and professionally health care administrator or population health with qualifications working with managed-care organizations. Goal oriented healthcare manager with background in healthcare operations and management. Advanced knowledge to oversee over hundreds of top-tiers behavioral health Hospitals/Facilities and Health Systems and groups other levels that consist with tiers three and single-case agreements that equates an estimate two hundred managed care accounts (i.e., Medicaid, Medicare, Combination insurance). Resourceful Account Manager with excellent client oversight, issue resolution, and relationship-building expertise. Maximized repeat business opportunities and utilized proven prospecting techniques to expand client base. High-level sales cycle knowledge and strong collaborative skills leading to optimum outcomes.
Overview
11
11
years of professional experience
Work History
Provider Relationship Account Manager – Behavioral Health/West TN Region
Wellpoint
04.2021 - Current
- Develops and maintains positive provider relationships with provider community by regular visits (e.g., on-site and/or virtual/digital visits), communication administrative and programmatic changes, and facilitating, education and the resolution of provider issues
- Serves as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction; researches and resolves the most complex provider issues and appeals for prompt resolution
- Assigned to higher level, Tier 1/Platinum providers, and handles other tiers levels as assigned (Tier 2-4)
- Coordinates Joint Operation Committees (JOC) of Tier1/Platinum provider groups, driving the meeting in the discussion of issues and changes
- Conducts provider experience meetings that consist of provider education; compliance, False Claims Act, Cultural Competency, MEGA requirements and other pertinent information to ensure provider is well informed of requirements
- Provides support regarding Annual Provider Satisfaction Surveys and monitoring, education, contract questions of issues and changes
- Coordinates prompt claims resolutions through direct contract with providers, claims, pricing, and medical management department
- Identifies, reports on provider utilization patterns, which have a direct impact on the quality of service delivery
- Serves as subject matter expert, tracks and conducts provider refresher training
- Assigned responsibilities includes researching issues that may impact future provider negotiations or jeopardize network retention
- Other responsibilities include working with Tennessee Health Link - Behavioral Health professionals associated with mental health clinic or other behavioral health provider who provides whole-person, patient-centered, coordinated care for assigned panel of members with behavioral health conditions
- Functions as high-level technical resource to resolve or facilitate complex provider issues
- Provider Relations and/or Health Care Management Services staff review and update advance directive notices and education materials for members on regular basis
- Generates population analytics reports to review impacted claims issues and concerns for resolution to include review of billing codes associated complexity of claim issues
- Knowledgeable to utilize systems; Salesforce, Facets, MS Teams, and using other organization systems to perform day-to-day job duties
- Frequent user of computer systems: Facets, Macess, Salesforces, Product lifecycle management (PLM2/SPS), PEGA PCM, InterAct, PERM, GBD Medicaid Claims Research Reports-Tableau, and other company systems
Compliance Manager/Quality Management
MEMPHIS HEALTH CENTER, INC.
02.2016 - 04.2021
- Spearheaded NCQA PCMH recognition since 2011-2014, 2016-2021 utilized a combination of accreditation under several of the PCMH Survey Tool (e.g., 2011, 2014, 2016, 2018, etc.) to ensure the organization maintain recognitions
- NCQA PCMH Content Expert, demonstrate comprehensive knowledge of the PCMH model of care and the NCQA PCMH Recognition Program, including a mastery of the NCQA concepts, criteria and the PCMH Recognition protocols, that includes ensuring the entire organization (four locations that included Adult Medicine, Pediatrics, Behavioral Health, OBGYN) adhere to the requirements, attestations, virtual check-ins, population analytics, and direct support from C-Suite
- Manage the overall NCQA multi-year project life cycle, creation of project plans and schedules, manage resources and facilitate project execution, deployment, and closure
- Collaboration with the State of Tennessee PCMH Program that included project management for the initiative program during the first development under Wave 1 in 2011
- Plan and manage projects related to process improvement through decrease variation, cost, and cycle times, enhancing safety and promoting evidence-based performance outcomes
- Implemented population health campaigns (i.e., Colorectal, Childhood Immunizations, Wellness Visits) with members, resulting in 90% of the clinics achieving target goals
- Assessed performance against Joint Commission, HRSA Program Requirements, HEDIS, Managed-Care Organizations (BlueCare, UHC, Amerigroup, WellCare, and Humana), and other entities standards, state and federal regulations, governance criteria and identified opportunities for improvement and implemented action plans
- Site overseer for ACO (Accountable Care Organization), pay for performance, reviewing contracts, quality measures to close gaps in care, educating and training other staff (PCMH Coordinators)
- Developed, compiled, and reported quality data to management and regulatory and accreditation bodies and quality improvement organizations
- Facilitated Root Cause Analysis (RCA), Fishbone, Failure Modes Effects Analysis (FMEA) with other management staff
- Received, investigated, and responded to patient complaints and tracked and trended complaints data to initiate performance improvement activities
- Worked with leadership team to established and implemented clinic balanced scorecard based on core values; including over 15 clinical and administrative outcome measurements used to identify areas of needed improvement
- Drafted and revised organization policies regarding patient safety, infection prevention and control, diagnostic and X-Ray, clinical operating procedures, pharmacy, risk management, environment of care, emergency management plan to maintain compliance with evolving regulatory requirements
- Led clinical quality and performance improvement efforts for federally qualified health center serving over 20,000 underserved and underprivileged patients in Shelby County and Fayette County
- Led organization two (2) times in 2016 and 2019 in preparedness for unannounced Joint Commission Accreditation surveys and resulted in receiving accreditations for an additional 36 months
- Facilitated collaborate projects with care providers and the executive leadership team to devise and implement targeted improvement projects including direct patient in reach efforts to positively impact volume and improve clinical outcomes
- Develop multiple process improvements to streamline patient communication, clinical documentation, and patient satisfaction through patient interactions, third-party vendors reporting surveys, and lean healthcare management with (fishbone, system analysis)
- Planning and conducting internal audits and/or assessments to evaluate compliance of federal, state, and other regulatory guidelines
- Develop, initiate, maintain, and revise policies and procedures for the general operation of the compliance program and its related activities to prevent illegal, unethical, or improper conduct
- Develop a compliance program aimed at reducing risk for a community health clinic organization
- Collaborates with other departments to direct compliance issues to appropriate existing channels for investigation and resolution
- Knowledgeable Medicaid and Medicare requirements
- Oversees and manages the Continuous Quality Improvement (CQI) Committee and provides reports on a regular basis, and as directed, keep the Executive Management Team and the Board of Governors informed of the operation and progress of compliance efforts
- Participate on committees such as CQI, Quality Improvement Board Committee and Risk Management Committee and Executive Leadership Committee
- Manage all components of NCQA programs, accreditation work plan, quality initiatives and multidisciplinary interdepartmental teams to maintain compliance and state of readiness for Accreditation
- Led project organization for organization COVID-19 vaccine program protocol, established written policies and procedures with other leaders within the organization, ensure compliance with vaccine reconciliation in TennIIS
Compliance Audit Specialist
MEDTRONIC SPINAL GRAFT TISSUE (SGT)
12.2013 - 02.2016
- Coordinating and preparing audits external and internal audits (i.e., hospitals, consignment tissue sites, and manufacturing departments) to ensure compliance with regulatory standards with the FDA, AATB, The Joint Commission, ISO 13485:2003, other applicable state and federal regulations
- Analyzed audit data and presented findings to management, supported Corrective Action Plans, and provided coaching to business partners
- Oversee hospital audit included staff training, storage temperature and monitoring, reviewing hospital policies and procedures to ensure no gaps in standards
- Investigated and resolved compliance problems, questions, or complaints received from other units of the company, customers, and government regulatory agencies
- Performing risk assessments for new tissue consignment sites; supported hospital and distribution sites within Medtronic SGT & OTI Human Allograft Tissue consignment program including acting as point of contact and resolving issues according to the organization policies and procedures
- Managed special project to re-designed audit tool for auditors and customized an excel report for auditors to track and schedule over 200 Hospital Tissue Consignments
- Responsibilities includes to monitor controlled document process for tissue handling procedures and forms, ensuring compliance and efficiency; investigated and resolved compliance gaps and/or complaints regarding SGT/OTI tissue products
- Conducting and performing calibration on tissue storage device Smart Storage Cabinet and providing results and report to SGT management team and hospital
- Thorough knowledge and understanding in utilizing the Quality Manual through Quality Management System (QMS) to ensure quality procedures were maintained and followed during quality related activities used by Medtronic, employees, operations, products, and facilities located throughout the organization and distributions sites during audits
- During internal and external audits followed specific regulations and standards under 21 CFR Part 820 for medical devices (also referred to as GMPs/Good Manufacturing Practices) and ISO 13485 (governs medical)
- Monitored data from the QMS that takes system inputs from customers that are used for product, manufacturing, and distribution to monitor and analyze feedback from customers
- Participated as a compliance auditor to review QMS activities that meet the requirements of laws and regulations for FDA inspections and Medtronic Corporate Policies and other applicable quality system regulations or standards
- Participated in a special project to align Quality Manuals with corporate policies and spinal graft tissue policies to review redundant policies for opportunities to merge or make obsolete
- Generated assigned hospital accounts audit report and findings were documented in Trackwise CAPA system; resolved findings to include effectiveness checks to close CAPAs as defined in policies
- Received recognition and staff award points for two major projects (i.e., Redesigning Tissue Consignment Audit Schedule and Researching Gaps in Hospitals Tissue Consignment Annual Audits)
Education
Lean Healthcare Certification -
Belmont University
Nashville, TN01.2019
Master of Business Administration -
University of Phoenix
Phoenix, AZ01.2010
Bachelor of Science - Health Administration
University of Phoenix
Cordova, TN01.2007
Skills
- Healthcare Management
- Quality Improvement
- Accreditation Standards & State License
- Policy & Procedure Design & Implementation
- Cross-Functional Team Collaboration
- Regulatory Compliance & Audit
- Patient Centered Medical Home (PCMH)
- Healthcare Medicare and Medicaid
- NCQA Content Expert
- Quality Manual and QMS experience
- Client Relationship Management
- Teamwork and Collaboration
- Contract Negotiation
- Cross-Functional Collaboration
- Data Analytics
- Data-driven decision-making
- Account Management
Degrees
- BSHA
- MBA
Timeline
Provider Relationship Account Manager – Behavioral Health/West TN Region
Wellpoint
04.2021 - Current
Compliance Manager/Quality Management
MEMPHIS HEALTH CENTER, INC.
02.2016 - 04.2021
Compliance Audit Specialist
MEDTRONIC SPINAL GRAFT TISSUE (SGT)
12.2013 - 02.2016
Lean Healthcare Certification -
Belmont University
Master of Business Administration -
University of Phoenix
Bachelor of Science - Health Administration
University of Phoenix
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