Call Center Behavioral Health
Resume:
Jose A. Febus
**** * ****** *** #** Fullerton, CA 92833
**********@*****.*** 714-***-****
Call Center & Operations Management
Healthcare Professional with 25+ Years of Experience
Results-oriented healthcare professional with broad experience in recruiting clients and developing strong team cultures in a diverse workforce. Proven ability to transfer skills across varied industries, including overall operations, pharmacy benefit management, distribution, hospitals, retail, managed care, and IPA management. Known for using innovative strategies to increase employee morale and staff retention rates, which improves customer satisfaction. Skilled in Production (NICE), RIMS, Iliad, Avaya, TotalView, IEX, CMS Supervisor, AS400, Genesys, RingCentral and other software applications that pertain to the healthcare industry.
Highlights of Expertise
Customer Satisfaction & Client Onboarding
Leadership & Management of Operational Teams
Policy Implementation & Optimization
Key Performance Indicators (KPI)
Hiring, Recruitment and Retention
Medical Terminology
Client Data Organization & Optimization
Data Analysis & Quality Control
Specialized Software
Interpersonal Communications
Implementing Department Procedures & Policy
5 STAR Quality committee
Career Summary
manager, behavioral health call center 2022 - present
CenCal Health Santa Barbara
Behavioral Health Call Center Manager is responsible for the management of the Behavioral Health (BH) Call Center operations. The Behavioral Health Call Center Manager is responsible for ensuring accurate and efficient handling of all member and provider calls, continuity of care requests, support referrals between County ACCESS lines, support and triage crisis and escalated calls, clinical consultations with providers, the accuracy of call tracking for all calls, and supervision of Behavioral Health Call Center Supervisor. Includes monitoring of staff's phone queue adherence, phone call monitoring for quality assurance, handling escalated Behavioral Health calls for members needing to speak with a manager, monitoring performance related to established goals for the department and regulatory requirements.
Director of Call Center Enterprise Operations 2019 - 2022
agilon Health Anaheim
The Customer Service Director is responsible for identifying and developing all culture, process and performance improvements and efficiencies for the customer and for leading/developing a team, who typically deliver customer interactions across multiple channels
Oversee the data customer service team and manage performance
Provide daily direction and communication to employees so that customer service calls are answered in a timely, efficient and knowledgeable manner.
Provide continual evaluation of processes and procedures. Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers.
Monitor and manage departmental and staff goals, utilizing the call monitor, reports and other system tools to ensure the targets are met.
Develop and implement action plans to ensure the department is successful in meeting targets.
Assist with daily operations of the call center to include the development, analyses and implementation of staffing, training, scheduling and reward/recognition programs.
Supports and coordinates day-to-day department activities by providing strong leadership to the department supervisors through one-on-one communication, team meetings, individual coaching, teaching and evaluating
Create and maintain a high-quality work environment so team members are motivated to perform at their highest level.
Work as a member/leader of special or ongoing projects that are important to area/process improvement.
Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives.
Uses appropriate judgment in upward communication regarding department or employee concerns.
MANAGER of Call Center Enterprise Operations 2017 – 2019
agilon Health Anaheim
The Customer Service Manager is responsible for guiding, developing and managing the customer service team and internal processes. This position works together with internal partners to satisfy the customers' needs by maintaining strong relationships, proactive account management and outstanding customer service. They will respond to member and provider complaints, requests or concerns to ensure the success of business goals and customer satisfaction.
Oversee the data customer service team and manage performance
Provide daily direction and communication to employees so that customer service calls are answered in a timely, efficient and knowledgeable manner.
Provide continual evaluation of processes and procedures. Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers.
Monitor and manage departmental and staff goals, utilizing the call monitor, reports and other system tools to ensure the targets are met.
Develop and implement action plans to ensure the department is successful in meeting targets.
Assist with daily operations of the call center to include the development, analyses and implementation of staffing, training, scheduling and reward/recognition programs.
Supports and coordinates day-to-day department activities by providing strong leadership to the department supervisors through one-on-one communication, team meetings, individual coaching, teaching and evaluating
Create and maintain a high-quality work environment so team members are motivated to perform at their highest level.
Work as a member/leader of special or ongoing projects that are important to area/process improvement.
Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives.
Uses appropriate judgment in upward communication regarding department or employee concerns.
MANAGER of Operations (Member Services) 2017 – 2018
SCAN Health Plan Long Beach
Manages the overall operations of Member Services (MS), Provider Claims contact centers and Quality. Ensures that members and providers receive a high level of service by leveraging technology and staff.
Supports and coordinates day-to-day department activities by providing strong leadership to the department supervisors through one-on-one communication, team meetings, individual coaching, teaching and evaluating
Assigned, tracked and monitored quality issues, including CTM and Grievance and Appeal cases assigned to department, to ensure regulatory timelines are met and documented accurately in accordance with specified Policies and Procedures.
Promoted customer satisfaction and compliance with internal policies and procedures, and regulations through an effective quality monitoring program.
Provided interpretation of Benefits, Delegated Contracts, and Provider contracts in matters regarding the claim function.
Coordinated member notification mailings, including provider terminations, benefit changes, and EOCs. Supervised process of addressing incoming mail, including inquiries, returned mail, and electronic communications.
Prepared compliance and operational reports and metrics, including summarizing/analyzing data and trends, and plan for future improvements/corrective action plans
Supports regulator and internal audits, serving as the process owner and subject matter expert, including case development, auditor interviews, reviewing reports and developing, implementing and monitor corrective action plans, as needed.
Promoted compliance with all regulatory standards including Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS) and HIPAA. Prepares for and participates in regulator audits/reviews. Oversee errors that impact the ability to authorize payments at the point of sale
Manage the feedback log to track data to improve performance and accuracy
MANAGER of Operations 2005 – 2016
Optum/UnitedHealth Group Costa Mesa
Managed the adherence technician teams to review and remediate cancellations, potential risks, cases triaged to other departments, and cases that require manual oversight. Supervised individual teams and interdepartmental communications.
Responsible for monitoring adherence, compliance, client onboarding, and authorization review
Responsible for quality management for coverage determinations for Part D members
Lead compliance team for CMS audits preparations for prior authorization
Oversee errors that impact the ability to authorize payments at the point of sale
Manage the feedback log to track data to improve performance and accuracy
Coordinate client onboarding and review processes to ensure client satisfaction and develop new processes
Successfully integrated two departments to achieve synergies. Trained all new systems
Designate team responsibility in order to continually support successful correspondence objectives
Responsible for the oversight of correspondence, including missing communication records
Manage quality team for HIPAA monitoring
Pharmacy Operations
2008 - 2016
Increased productivity while simultaneously reducing AHT by 30%
Increased departmental schedule adherence from 58% to 97%
Coordinate multiple sites and 450+ employees, including pharmacy technicians and contract staff
Serve as an offshore liaison and co-manage all offshore training initiatives
Create metrics and quality assurance for call center operations
Forecast staffing needs based on volume trends and workload
Co-manage forecasting and staffing needs based on volume, trends and workload
Create and manage department metrics, including the glide paths for new hires
Co-developed specialty and standard quality guidelines
Fostered relations with clients by addressing all concerns and implementing plans to remediate matters
Participated in a company acquisition and merger to offer expertise in decisions on for integrating clients and developing new system training
Implemented the manual Proactive PA process and partnered with IT in its automation
Responsible for high profile projects with a focus on gaps in department processes
Cut company costs by evaluating outliers and documentation errors
Phone Operations Supervisor
2006 - 2008
Team Lead for the Pharmacy Technician Operations Supervisors
Streamlined communications between client relation managers and implementation department
Reviewed quality statistics with agents on how to improve their performance
Conducted monthly staff collaborations and one-on-one meetings
Performed monthly call monitoring evaluations to ensure quality control
Modified timelines and work schedules according to business needs
Customer Service Supervisor
2005 - 2006
Increased call handle times by 80% by developing new training procedures and manuals
Implemented new client programs to call center staff while acting as a liaison for other impacted divisions of the company
Created the disaster recovery and contingency plans
Enforced high-standard performance while maintaining a strong team culture.
Conducted monthly staff and one on one meetings
Handled all human resource issues, including interviews and applicant evaluations
Developed new systems that successfully increased productivity and quality of work
Education & Credentials
HERBERT LEHMAN COLLEGE Bronx, NY
Bachelor of Arts in Psychology
Associates of Science in Pre-Pharmacy
LICENSE
California Pharmacy Technician License No. 40481
TRAINING
Coaching for Performance Improvement Facilitating Successful Projects Managing Successful Meetings
Situational Leadership
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