Summary
Overview
Work History
Education
Skills
Clubs & Memberships
Timeline
Generic

Agata B. Johnson

Murfreesboro

Summary

Results-driven professional with proven track record of leadership excellence. Skilled in strategic planning, team collaboration, and driving projects to successful completion. Strong focus on fostering collaborative environment, ensuring adaptability, and delivering impactful outcomes. Known for effective communication, problem-solving acumen, and unwavering reliability in dynamic settings.

Overview

6
6
years of professional experience

Work History

Home Health (CSOC L2-Team Leader)

H&C
05.2019 - Current
  • Process inbound and outbound data and communication (i.e., faxes, emails, and electronic communication) according to productivity and quality standards
  • Enter data, review clinicals as well as HIPAA verification into the CM database accurately and in a timely manner
  • Complete administrative documentation for member records including but not limited to transitioning, creating authorization shells, and attaching documents (i.e., medical records)
  • Assist in a smooth coordination of members care between health providers and the health plan
  • Establish relationships and communicate, when appropriate, to providers, clients and/or H&C field/CM staff as defined by departmental policy and processes
  • Triage inbound calls, manage member inquiries/requests, and resolve or escalates to appropriate nH or health plan personnel
  • Manage reports to monitor that assigned team duties are completed by line staff
  • Serve as the beta end user for process improvement initiatives and new contract/client implementations, providing feedback and recommendations to the manager and influencing process definition
  • Precept and mentor new colleagues during and after initial training
  • First line of peer support for operational and procedural questions and/or concerns
  • Escalate opportunities for coaching/training to management
  • Complete reports to assist the Central Support Department
  • Follow chain of command as appropriate when reporting issues or concerns
  • Adhere to organizational, departmental, compliance and regulatory policies and procedures
  • Promote a positive attitude and work environment
  • Perform other duties and responsibilities as required, assigned, or requested
  • CM Salesforce (Pre-Service Escalations) – Mini Project (Nov 2021 - Current)
  • Precepting - train CSOCs on tasks or new process Jan 2023)
  • HCHB – Upload clinicals for Amedisys GA contracts (May 2022)
  • Developed virtual educational material for class and individual settings, for new hire staff
  • Designed and maintain my team’s training calendar, to ensure staff is using updated processes
  • NH Access – Managed tickets to maintain correct customer data in the system & maintain current info in internal tracking system for all assigned systems (December 2023)
  • Identified team weak points and implemented corrective actions to resolve concerns.
  • Trained employees on different task & new processes.
  • Led team by answering complex customer questions and mentoring personnel one-on-one.
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.

DENC

H&C (UHC/Optum)
02.2021 - 05.2021
  • Company Overview: United Healthcare Group/Optum
  • Call PAC get a fax number and person who will be delivering DENC letter to member that day
  • Document calls in Provider Verbal Notification
  • Send DENC letter thru Outbound Fax
  • Upload KEPRO or LIVANTA in appropriate portal
  • Update the Appeals folder with information from call and confirmation of email fax
  • Update 'Create Patient Letters' with date and time of email fax
  • Update Approved line to add pending line and update time and date when KEPRO or LIVANTA was created
  • Humana Only: Download DENC and NOMNC, save and upload to Humana Folder in N Drive as well making sure NOMNC letter is signed

ATS Queue

H&C
12.2020 - 05.2021
  • Company Overview: United Healthcare Group/Optum
  • For 1st attempt call requester for Initial Clinical
  • Send Test Fax through Outbound Fax if requester's fax number is not in address book; if caller verifies test fax was received; send email to Test Fax with information to add to address book
  • Call to verify ACD if needed and document in comments
  • For 2nd attempt fax additional form thru Outbound Fax if facility is not in address book call instead
  • Prior to calling for clinicals check View Documents/Requests to see if clinical have been upload; if so, send to PSC Queue
  • Make sure to document all calls for clinical request in 'Provider Clinical Requests'
  • United Healthcare Group/Optum

APEX

H&C
03.2020 - 05.2021
  • Company Overview: United Healthcare Group/Optum
  • Make only 2 attempts to call the Requester to provide PVN (Provider Verbal Notification) (Auth Details)
  • Document calls in Provider Verbal Notification
  • Document in comment sent alert to SICC assign to PAC, alert SICC and update Auth Manager to SICC name
  • If no SICC is listed send email to the CTM (Clinical Team Manager) for the PAC to assign an SICC
  • Remove from queue once 2 attempts whether successful or not
  • United Healthcare Group/Optum

ATS Queue

H&C
08.2019 - 03.2020
  • Company Overview: United Healthcare Group/Optum
  • For 1st attempt call requester for Initial Clinical
  • Send Test Fax through Outbound Fax if requester's fax number is not in address book; if caller verifies test fax was received; send email to Test Fax with information to add to address book
  • Call to verify ACD if needed and document in comments
  • For 2nd attempt fax additional form thru Outbound Fax if facility is not in address book call instead
  • Prior to calling for clinicals check View Documents/Requests to see if clinical have been upload; if so, send to PSC Queue
  • Make sure to document all calls for clinical request in 'Provider Clinical Requests'
  • United Healthcare Group/Optum

HIB (Head in Bed)

H&C
09.2019 - 02.2020
  • Company Overview: United Healthcare Group/Optum
  • Call PAC to confirm if Member admitted to PAC and verify date of admission
  • Follow up for HIB check if member has not been admitted within 6 calendars of Decision Date
  • If Member admitted within these days follow process to closing auth and provide HP number to caller
  • If member has/has not admitted outside of 6 calendars of Decision Date send task to PSC queue to follow up
  • United Healthcare Group/Optum

Faxes & Inbound/Outbound Calls

H&C
05.2019 - 08.2019
  • Company Overview: United Healthcare Group/Optum
  • Collect accurate inspection data and be able to report these findings to operational personnel
  • Manage inbound and outbound telephone communication in a professional manner and according to productivity and quality standards
  • Process inbound and outbound data and communication (i.e., faxes, emails, and electronic communication) according to productivity and quality standards
  • Enter, review and or verify member information in the nH Coordinate care management platform and communicate approved pertinent information with healthcare providers and/or nH team as needed
  • Enter the required data into the nH database accurately and in a timely manner
  • Complete administrative documentation for member records including but not limited to transitioning, creating authorization shells, and attaching documents (i.e., medical records)
  • Assist in a smooth coordination of members care between health providers and the health plan
  • Establish relationships and communicate, when appropriate, to providers, clients and/or nH field/care management staff as defined by departmental policy and process
  • Triage inbound calls manage member inquiries/requests, and resolve or escalates to appropriate nH or health plan personnel
  • Run and/or review reports to monitor assigned team duties are completed
  • Follow chain of command as appropriate when reporting issues or concerns
  • Adhere to organizational, departmental, compliance and regulatory policies and procedures
  • Promote a positive attitude and work environment
  • Perform other duties and responsibilities as required, assigned, or requested
  • United Healthcare Group/Optum

Education

Master of Justice Studies - Public Administration

Southern New Hampshire University
Manchester, NH
10.2016

Forensic Psychology Certificate -

The Chicago School of Professional Psychology
Chicago, IL
06.2010

Bachelor of Science - Criminal Justice

American InterContinental University
Weston, FL
09.2009

Associate in Arts -

Coastal Carolina Community College
Jacksonville, NC
05.2006

Skills

  • Relationship building
  • Conflict resolution
  • Strategic planning
  • Motivating teams
  • Continuous and Process improvements
  • Team leadership, Teamwork and Collaboration
  • Goal oriented and Goal setting
  • Processes and procedures
  • Organizational skills and Attention to detail
  • Multitasking Abilities
  • Problem-solving abilities
  • Customer service and Active listening
  • Ability to learn new things
  • Reliability
  • Training and mentoring
  • Microsoft Office

Clubs & Memberships

  • Guardian Ad Litem, 01/01/10, 01/01/13
  • Gamma Beta Phi Society, 01/01/07, 01/01/09
  • Student Government Association (SGA), 01/01/07, 01/01/09
  • Friendship Club (Handicap and Special Needs), 01/01/94, 01/01/96
  • Young Marines, 01/01/96, 01/01/01
  • Explorer, 01/01/98, 01/01/01

Timeline

DENC

H&C (UHC/Optum)
02.2021 - 05.2021

ATS Queue

H&C
12.2020 - 05.2021

APEX

H&C
03.2020 - 05.2021

HIB (Head in Bed)

H&C
09.2019 - 02.2020

ATS Queue

H&C
08.2019 - 03.2020

Home Health (CSOC L2-Team Leader)

H&C
05.2019 - Current

Faxes & Inbound/Outbound Calls

H&C
05.2019 - 08.2019

Bachelor of Science - Criminal Justice

American InterContinental University

Associate in Arts -

Coastal Carolina Community College

Master of Justice Studies - Public Administration

Southern New Hampshire University

Forensic Psychology Certificate -

The Chicago School of Professional Psychology

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Agata B. Johnson