Manager, Facilitatator, Trainer

Licia Avette Johnson

CAREER PROFILE

Strategic/pro-active healthcare professional with proven proficiencies in all areas of training and customer service. Background experience in diverse healthcare environments including corporate and military. Exposure to business development, business processes & the relationship to functional processes, market research and client relationship management. I served in Desert Storm/Desert Shield in 1992. I am currently rated as a 40% Disabled Veteran.

Highlights of Qualifications

Results oriented leader

Team Building & Training

Quality Control

Strategic Planning

Project Management

Market Research

Customer Service

Managed Care Experience

Compliancy/Auditing

Experience:

Processing Point 3/2017 to Present

Client Support, Manager, Carlsbad, CA

• Coordinate operations.

• Ensure schedules and objectives are met.

• Supervise the largest department that consist of 25 Technicians

• Monitor resources.

• Communicate with clients and evaluate their needs and specifications.

• Create reports, analyze and interpret data.

• Devise and implement internal and external metrics and analysis.

• Secure adherence to company's policies and guidelines.

• Quickly learn new software, hardware and related concepts.

• Knowledge of ACD/PBX based phone systems and call queue structure.

• Problem solves issues that may be non-standard and require resourceful, conceptual thinking.

• Actively listens to customers, understands their issues and communicates resolutions effectively both verbally and written.

• Works well under pressure with the ability to be patient and display empathy.

• Ability to multi-task while remaining detail oriented.

• Documents customer and internal interactions.

• Proficiency with MS Office.

• Proficiency with CRM / ticket systems.

• Identifies,resolves and/or escalates priority issues to appropriate resources.

Processing Point 01/2017-03/2017

Client Support, Assistant Manager, Carlsbad, CA

• Oversee the day to day operations in a fast-paced, inbound call center environment as well as implement long term objectives and strategies. Prioritize and resolve customer issues as well as provide mentoring and coaching to the Customer Service Team.

• Manage a call center in a technology based environment. Organize and assess issues from an analytical perspective, making logical decisions under pressure.

• Proficient time management skills, including but not limited to; prioritizing customer issues, implementing directives from the Client Services Manager, maintaining employee work and internal training schedules.

Key Responsibilities:

• Assist the CS manager in organizing, planning and implementing strategy.

• Be available after hours and weekends as needed.

• Coordinate operations.

• Ensure schedules and objectives are met.

• Supervise staff.

• Monitor resources.

• Communicate with clients and evaluate their needs and specifications.

• Create reports, analyze and interpret data.

• Devise and implement internal and external metrics and analysis.

• Secure adherence to company's policies and guidelines.

• Quickly learn new software, hardware and related concepts.

• Knowledge of ACD/PBX based phone systems and call queue structure.

• Problem solves issues that may be non-standard and require resourceful, conceptual thinking.

• Actively listens to customers, understands their issues and communicates resolutions effectively both verbally and written.

• Works well under pressure with the ability to be patient and display empathy.

• Ability to multi-task while remaining detail oriented.

• Documents customer and internal interactions.

• Proficiency with MS Office.

• Proficiency with CRM / ticket systems.

• Identifies, resolves and/or escalates priority issues to appropriate resources.

Rady Children Hospital, San Diego, CA 8/2016 to 12/2016 Financial Services, Supervisor

Responsible for the day-to-day activities of the PFS Billing, Reimbursement, Denials Management, Support Services, or Cash Management Team.

Interacts frequently with staff and leadership of the revenue cycle teams throughout the organization including but not limited to Patient Access, Revenue Cycle, Health Information Management, Utilization Management/Case Management, Charge Capture, Contract Management, and Information Technology Services.

Frequent interaction with system vendors as well as outsourced agencies and Third Party payer groups.

Responsible for organizing and supervising all work of the team members and ensuring timely processing of accounts either from a billing, collections, denials management, cash management, or PFS support services perspective. R

Responsible each month to supervise the root cause analysis of the designated initiatives that prevent timely billing or collection of accounts assigned to each team member and assimilate the data into readable and useful tools for analysis.

Works in collaboration with the PFS Manager for making recommendations to the PFS Leadership Team for resolution and elimination where possible.

Works in collaboration with all departments and units in the revenue cycle to appropriately communicate issues and/or barriers, and to formulate work plans for resolution each month of the trended issues.

Generates, provides data validation, and quality assurance of all monthly Accounts Receivable reports that are distributed to the organization and is knowledgeable of the contents and can provide information and answer questions when necessary.

Provides training and competency evaluation of team members as it relates to specific job functions and responsibilities.

TriWest Healthcare Alliance, San Diego, CA 02/2016-07/2016

QA and Training Supervisor

Partners with peers at remote locations to streamline quality assurance and training programs to improve operational quality levels at all locations.

Ensures that training from on-boarding to on-the job is consistent and effective.

Develops ongoing trainer effectiveness assessments, monitors training effectiveness outcomes implements training interventions as needed.

Coordinate with Operations Support management to identify training gaps and develop training plans to address performance improvement goals.

Coordinate with Quality Assurance Analysts and Participates in the implementation of systems designed to measure process and performance.

Contributes to program governance, project reviews, cross-functional communications, training, and rewards programs.

Serves as a change agent promoting development and integration of systems-thinking, customer focus, and commitment to continuous process improvement.

Serves as SME on review committees and annual document reviews

Ensure quality check process exists for quality assurance data before posted to official reports and scorecards

Evaluate call recordings and other relevant documentation and policies to provide written responses to complex case reviews as requested by management

Creates active change by facilitating issue identification, research, and cross-functional corrective action.

Partners cross-functionally to promote high-quality of CLASS model and accuracy.

Works with Management and Quality Assurance team to implement site specific action plans as needed

Oversees department quality assurance analysts and trainers staff, assigning and monitoring workflow. Oversee training for new staff, including departmental-specific and on-the-job training components.

Delivers training and remedial coaching for direct reports to promote position specific performance improvement.

Participates in special projects and meetings.

Triwest, San Diego, CA 09/2015 – 02/2016

PSR Supervisor

Supervise, train, coaches and develop the Patient Service Representative team

Supervise daily operations and oversee daily outcomes in the Customer Service Contact Center

Ensure that compliance with the VAPCCC requirements and TriWest policies and procedures are met

Ensure accurate completion of VA approved medical authorizations, appointment scheduling and thorough documentation of all Veteran encounters are documented

Directly interact with a variety of internal and external customers on a daily basis

Work a detailed, multi-tasked and a fast-paced production environment

Vista Community Clinic, Vista/Oceanside, CA 01/2015 – 08/2015

Patient Enrollment Manager

Manage Enrollment Staff and functions, including but not limited to, Medi-Cal applications, Covered CA applications, CalFresh Applications and Cash Aid Applications

Develop and manage processes to screen 100% of scheduled new patients for UDS/Insurance/Demographic and financial screening including scheduling with a Certified Enrollment Counselor

Create, Coordinate and Conduct New Patient Orientation processes and procedures

Coordinate with other departments as necessary to include but isn’t limited to Outreach/Marketing/Call Center/Billing and Clinic Operations

Develop a system to outreach all newly assigned Managed MCal patients, including scheduling appointments and follow up of no shows specific to outreach appointments

Create a Marketing and Patient Satisfaction/Retention Materials for clinic use

Responsible for Admin and implementation of work plan and budgets

Responsible for budget tracking/fiscal accounting and assuring that program expenses are allowable within contract terms

Responsible for recommending and generating budget revisions and justifications

Prepare all required reports and maintain records per policy

Report any unusual occurrences or incidents to supervisor and clinic administration

Prepare training curriculum and provide on-going training to staff as required/needed

Develop a best practice process to verify same day/walk in new patients using specific screening requirements

Compile statistics and reports specific to the number of clients assisted in Enrollment, including application status, health insurance retention, healthcare utilization, and other information as needed

Developed a Quality Assurance grid and implemented a system designed to measure process and performance for the clinic goals.

Act as the liaison between the patient, healthcare insurance group, and VCC for enrollment information, and for maintenance of healthcare insurance redeterminations, and missed opportunities (clinical services)

Responsible for grant funded projects

Conduct community outreach and contact and schedule appointments for potential new patients and existing patients

Artech assigned to Kaiser Permanente (Contract), San Diego, CA, 05/2014 – 09/2014

CTM Business Consultant/Analyst

Researced & monitored CTM cases to enable organizational compliance with all applicable CMS, Federal, state, and local regulations/laws

Identified opportunities for business process improvement through various meetings with business users and developers

Assigned to investigate, document, and analyze client requirements in areas of new/existing business operating models

Developed innovative approaches to solutions, support and market research of emerging or available product functionality and operational readiness assessment

Participated in workflows, processes diagrams, gap analysis & reported metrics

Utilized project planning tools by coordinating with cross-functional teams for quality data and analysis.

Conducted training for a 15-member team on product, processes, usage of systems and document management (Share Point).

Physician Data Trust- ST. Vincent IPA (Contract), Los Angeles, CA 04/2013 – 11/2013

SNP Case Manager/Health Educator/UM Manager

SNP Case Manager:

oWorked directly with patients and their families to coordinate, plan, and transition medical care, and facilitated communication that enabled speedy recovery without stress on patients, families, or physicians.

oMonitored patients with chronic medical conditions through the Disease Management Program and collaborated with clients to mold a personalized disease management plan exceeding health plan standards.

oThrough patient education, identified, monitored, and improved chronic disease symptoms and outbreaks.

oCoordinated health care interventions for target populations to reduce costs and optimize resources. Worked on-call and was accessible 24 hours a day to the members.

oCoordinated with 15 hospitalists to monitor all inpatient admits and communicate discharges to care management department.

UM/QA Manager

oMonitored all programs, inpatient stays, and ER visits to minimize over-usage and waste to improve the patients’ quality of life, the overall healthcare experience, and continually explored cost-efficient alternatives

oCompleted insurance audits to ensure that the Management Company was HIPAA and documentation compliant

oAs patient advocate, provided ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs

oAccountable for care, coordination and discharge planning of all patients, and coordinated the integration of case management functions into the patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities

oConducted concurrent medical record review using specific indicators and criteria as approved by medical staff, JCAHO, CMS, and other state agencies

oConducted reviews for appropriate utilization of services from admission through discharge

oFacilitated interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post-hospital needs.

Diamond Healthcare 04/2009 – 04/2012

Military Liaison

Officer-In-Charge for the Military members at Palomar/ Pomerado for both inpatient and outpatient Behavioral Health services

Acted as direct connection between the Commands and the Treatment Staff for both the Civilian and MTF Facilities.

Identified and referred potential cases to Disease Management, Case Management, Demand Management and Transitional Care.

Developed and increased the number of prospective Military adult patients to Behavioral Health Units by

Identified and cultivated the potential patients navigating through hospital admissions.

Helped patients adjust to being a Military member in a civilian setting & participated in education outreach forums

Identified and developed relationships with the Military Hospitals/Commands

Produced weekly/monthly reports & tracked the effectiveness of the referral sources and advertising media

Kaiser Permanente Hospital San Francisco/Daly City, CA 10/2007-12/2009

Health Educator (Per Diem)

Coordinated a wide range of health education services, including establishing effective referral and publicity systems, monitoring quality and documentation

Provided scheduling and logistical support, and facilitating use of community services to promote the delivery of cost-effective health education services.

Provided direct group or one-to-one health education services to members and the public.

Conducted needs assessments, established priorities, and evaluated basic health education programs, protocols, and standards.

Reviewed, developed, and recommended high quality, culturally appropriate, written and audio-visual health education materials and collateral for use in community health events, etc.

Prepared regular reports on activities

Army National Guard Reserves, San Mateo, CA 12/2007- Present

Medical Specialist

Planned, directed, and coordinated medicine and health services in hospitals, clinics, managed care organizations, public health agencies, or similar organizations

Planned, developed, and enforced health programs to maintain health and sanitation standards, regulations, and procedures designed to protect the public

Investigated cases of communicable diseases and implemented programs to prevent further spread of the disease

Performed a wide range of complex procedures in the general area of the clinical laboratory or perform specialized procedures in such areas as cytology, histology, and microbiology

Education/QA Trainer for Med Btn 297 providing support to the Western Pacific Region

DeAnza College 09/2006- 06/2007

Health Educator (Sabbatical Relief), Cupertino, CA

Provided health education information to students, faculty and staff through:

oWritten information, class presentations, and workshops

oAwareness campaigns & individual health education counseling

Developed goals, objectives and operational plans; coordinated activities with campus and community organizations.

Maintained current reference files on a variety of health related topics and organizations.

Recruited and trained student volunteers to assist in various Health Services-related events

Served as an advisor and a speaker for student clubs and organizations

Promoted Student Health Services to college and high school students

Created, developed and implemented awareness campaigns such as the Great American Smoke Out, Drug and Alcohol Awareness Week, and World AIDS Day

Organized the annual health fair and fund-raising events

Participated as a guest speaker for various classes on campus including Human Sexuality, Sociology, ESL, Math and Health classes, etc.

Developed, researched and wrote articles for a campus health newsletter for students and faculty

Performed a variety of administrative and clerical activities

US Navy 08/1991 – 05/1999

US Navy Reserves 05/1999 – 12/2007

Hospital Corpsman

Trained and supervised new Hospital Corpsman in various departments

Administrative Assistant to the Critical Care Director and the Director of Nursing Services

Health Promotion Fitness Coordinator

Assisted in the prevention and treatment of disease and injuries

Prepared/administered medications including injections

Administered a Healthy Kids Immunization Program & rendered emergency care

Instructed sailors/marines in first aid, self aid, personal hygiene and BLS procedures

Transported the sick/injured & conducted preliminary physicals

Performed medical administration, supply and accounting procedures; maintained treatment records reports

Supervised shipboard and field environmental sanitation and preventative medicine programs; supervise air, water, food and habitability standards

Education

Doctorate of Theology, Faith Temple Christian College

Masters of Theology, Faith Temple Christian College

Masters of Education/Administration and Supervision, San Jose State University,

Bachelors of Science in Health Education, San Francisco State University

Certifications

National Registry of Food Safety Professionals - Food Safety Manager

Breathe California - Smoking Cessation Counselor

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