Gerunda Johnson
Zion,United States
Summary
Dedicated and Skilled professional knowledgeable about monitoring metrics and maximizing team success in fast-paced settings. Performance- and quality-driven with a vast years of experience. Natural leadership talent with motivational approach.
Overview
25
25
years of professional experience
Work History
Senior Clinical Administrative Coordinator
OptumHealth
Downers Grove, USA
07.2022 - Current
- Assist coordinators in navigating applicable systems, find resources, answer questions, and resolve problems.
- Acts as subject matter expertise in establishing processes for implementing new business, working in collaboration with the cross-functional departments to ensure readiness for new business implementations.
- Assist supervisors in the development of policies, procedures, job aids and guidelines for prior authorization processes.
- Identify and implement business development opportunities to support team/department growth.
- Collaborates with other department leaders for management of task inventory and work queues.
- Resolves escalated issues regarding member/provider requests engaging appropriate resources.
- Assists clinical operations department leadership in development of non-standard solutions to unique/challenging issues and implementations.
- Work directly with clients and/or internal account management contacts regarding processing requirements.
- Anticipates customer needs and proactively develops solutions to meet them.
- Reviews the work of others and educates staff regarding individual team opportunities for improvements.
- Serves as a leader/mentor and expert in specific tasks.
- Build relationships across departments to provide the best service to members.
- Lead functional or segment projects.
- Motivates and inspires other team members
- Train newly hired top talent to fill key positions and maximize productivity.
- Suggest and offer specific training programs to help workers maintain or improve job skills.
- Conduct onboarding sessions to orientate new staff members about company policies and procedures.
Clinical Administrative Coordinator
OptumHealth
Downers Grove, USA
02.2021 - Current
- Serve as primary point of contact for providers regarding prior authorizations.
- Document call history information and enter medical request data into computer systems.
- Review and advise provider of status of a request.
- Manage administrative intake of members Complex medical conditions.
- Handle and intake sensitive medical information for Cancer and Specialty Guidance program through usage of ICD 10 and CPT codes.
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers.
- Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles.
- Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review.
- Handle resolution/inquiries from members and/or providers.
- Work in a high-volume call center environment.
Field Support Specialist
TriWest Healthcare Alliance
North Chicago, USA
02.2019 - 10.2020
- Served as the primary point of contact between TriWest and our customer, the VA Medical Center Care, to effectively and efficiently support Veterans receiving care from a community provider.
- Performed service recovery with veterans, community providers and VA Medical Center staff when there are identified errors delaying care or payment of care or associated care.
- Worked in collaboration with the local VA Medical Center Advocates office to ensure issues are not escalated to the congressional level.
- Worked with the VA Medical Center Community Managed Care Team to reduce returns, resolve and maintain referral and authorization activity.
- Identified gaps in the TriWest network of licensed healthcare to deliver patient-centered care and with enrollment to update and maintain enrollment and eligibility information.
- Supported community Providers, ensuring the processing and payment of claims, identifying authorizations (not received by facility); possibly modifying authorizations requiring updating (CPT codes, secondary auth request education, secondary auth request inquiries and processing.
- Followed processes of the Department of Veterans Affairs (VA) program and perform all tasks in a courteous and professional manner.
- Protected the health care privacy of patients by strictly following HIPAA regulations.
- Researched systems to find missing information; coordinate with other TriWest departments to resolve issues.
Center Operations Manager
Grifols Plasma Center
Waukegan, USA
03.2007 - 02.2019
- Supervised and managed the overall operation of the plasma facility.
- Managed 50 full time employees annually and maintaining a below average turnover percentage.
- Investigated and resolved customer inquiries and complaints in an empathetic manner.
- Adhered to all confidentiality requirements at all times.
- Assumed ownership over team productivity and managed workflow to meet or exceed quality service goals/ KPI's.
- Trained staff on operating procedures and company services.
- Recruited, interviewed , hired, trained and coached on average of 50 new employees per year.
- Handled PTO request, scheduling and bi-weekly payroll, with ADP.
- Developed and achieved financial and growth goals.
- Managed a monthly budget of $500.
- Continually maintained and improved the company's reputation and positive image in the markets served.
Hospital Corpsman Second Class
US Navy
Great Lakes, Illinois
07.1999 - 02.2007
- Observed, recorded and reported patients' condition or injury and treatment provided.
- Maintained functionality and organization of medical treatment areas and provisions, including equipment maintenance and team leadership.
- Provided emotional support to patients who were experiencing distress due to illness or injury.
- Performed medical duties for preventive and unscheduled care by conducting lab work, x-rays, phlebotomy and IV fluid administration.
- Interpreted lab results accurately in order to diagnose conditions correctly.
- Administered medications and immunizations.
- Provided clinical instruction to lower ranking personnel on topics related to disease prevention and health promotion.
- Administered intravenous fluids and medications as prescribed by a physician or nurse practitioner.
Education
Bachelor's degree - Psychology
Capella University
Minneapolis, MNBachelor of Arts - General Studies
Eastern Illinois University
Charleston, ILHigh school diploma -
William T Dwyer High School
Palm Beach Gardens, FLSkills
- Quality assurance
- Call Center Experience
- Data Entry
- Military Experience
- Microsoft Office software
- CPT & ICD-9 Coding
- Training & Development
- Leadership Training
- Time Management
- Conflict Management
- Microsoft Access
Military Service
Navy, United States, E5, 07/31/99, 02/28/07, Hospital Corpsman (Medic)
Timeline
Senior Clinical Administrative Coordinator
OptumHealth
07.2022 - Current
Clinical Administrative Coordinator
OptumHealth
02.2021 - Current
Field Support Specialist
TriWest Healthcare Alliance
02.2019 - 10.2020
Center Operations Manager
Grifols Plasma Center
03.2007 - 02.2019
Hospital Corpsman Second Class
US Navy
07.1999 - 02.2007
Bachelor's degree - Psychology
Capella University
Bachelor of Arts - General Studies
Eastern Illinois University
High school diploma -
William T Dwyer High School
Similar Profiles
Dedra McElroyDedra McElroy
Family Nurse Practitioner at OptumHealthFamily Nurse Practitioner at OptumHealth
Hanna OyetundeHanna Oyetunde
Epic Ambulatory Go-Live Support ATE Specialist at OptumHealthEpic Ambulatory Go-Live Support ATE Specialist at OptumHealth
JD SiebsJD Siebs
Transpotation Coordinator at OptumHealthTranspotation Coordinator at OptumHealth