Imani Griffin, M.S. Email & Phone Number

Dallas, Tx, Us

Desoto, Texas, United States

As a results-driven healthcare leader with a proven track record, I successfully reduced denial rates by 30%, leading to the recoupment of 40% of denied revenue within a single year. In my role as Director of Utilization Management, I established and maintained effective Grievance and Appeals processes, ensuring data quality to support production and financial goals. I am adept at overseeing the entire revenue cycle management process, optimizing performance, and implementing strategic changes. My collaborative approach involves engaging with internal stakeholders, cross-functional teams, and executives to ensure alignment and support for Utilization Management initiatives. With a focus on evidence-based medical necessity criteria, I conduct telephonic clinical reviews, determine medical necessity, and collaborate on transition of care evaluations. As a senior resource, I provide leadership for a portfolio of projections, managing teams, financials, risks, issues, and quality assurance. My expertise extends to overseeing responses to service requests and interfacing with managed care organizations and external reviewers.

Desoto, Texas, United States

San Marcos, California, United States

•Manage the internal process flow to refine policies in a timely and efficient manner.•Perform telephonic/electronic precertification, concurrent utilization review, discharge planning, and case management for observation, acute care hospitalization, and skilled nursing facilities.•Collaborate cross-functionally with external and internal stakeholders and departments to ensure company security and to exceed industry standards.•Collaborate with physicians, care/service coordinators, & medical directors to coordinate and provide the appropriate level of care to meet members' health needs, ensuring proper utilization of health services that promote cost effective care. •Provide guidance on complex accounts and realigning priorities in response to emergent crises.•Oversee and evaluate compliance-related risks and serve as an internal resource during risk assessments and compliance-related Investigations. •Identifying departmental gaps in learning, service, and filing efficiency. Developed an internal audit process that has significantly improved our documentation accuracy and compliance to state and federal regulations surrounding sensitive patient health information, outcomes handling, and reporting.

San Marcos, California, United States

•Draft, edit, and publish Standard Operating Procedures (SOPs) to promote regulatory compliance, organization guidelines, and improve quality assurance. •Collaborate with stakeholders within the organization to conduct a quantitative and qualitative analysis of our filings, outcomes, and complaints to develop, implement, and evaluate the impact of pioneering and necessary Standard Operating Procedures, training, and workshops to improve all relevant compliance metrics. •Develop and maintain policies that contribute to the development and review of UR policies and Procedures that pertain to the operation and support of the UR Program •Conducts detailed analysis and examination of documents associated with the UR program. •Effectively maintains company structure through the application of laws and statutes and regulations required within the UR program. •Investigates complex cases and escalates unusual discrepancies to the supervisor to determine the best course of action for the client.•Ensures and organizes all information to adhere to state-mandated and required procedures.•Promoted twice due to exceptional attention to detail, leadership abilities, and fidelity of reports.

San Marcos, California, United States

- Evaluate and determine medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination, and compliance with state mandated regulations. • Assign appropriate Current Procedural Terminology (CPT) codes, International Classification of Diseases (ICD 10), & Diagnosis-Related Group for accurate billing. • Request and review medical records, physician and nursing notes, labs, assessments, history and physicals, and interview clinical staff including but not limited to specialists and nurses

Ontario, California

Key Achievement: Established a service ethos towards customers that contributed to an increase of $2.8 million in total annual revenue. Recommend, select, and help locate or obtain merchandise based on customer needs and desires. Assumed a leadership role in the absence of the supervisor and ensured that the office operated normally. Compare merchandise invoices to items actually received to ensure that shipments are correct.

Oceanside

Attend community events, meetings, or conferences to promote organizational goals or solicit donations or sponsorships. Contact corporate representatives, government officials, or community leaders to increase awareness of organizational causes, activities, or needs. Operate office machines, such as photocopiers and scanners, facsimile machines, voice mail systems, and personal computers. Type, format, proofread, and edit correspondence and other documents, from notes or dictating machines, using computers or typewriters. Review files, records, and other documents to obtain information to respond to requests.

Master Of Science - Ms, Psychology, 4.0

Bachelor Of Arts (B.A.), Sociology

Activities and Societies: Sigma Alpha Pi - National Honor Society of Leadership and Success

Associate Of Arts (A.A.), Liberal Arts And Humanities, 3.33

Activities and Societies: Team Captain of volleyball team.Student-Athlete at San Diego City College. Received Athlete of the Year. Ed.