Nicole Williams

Work History

Manager, Clinical Operations

Optum

08.2022 - Current

Managed 5 supervisors with 100 indirect reports
Achieved departmental goals by developing and executing strategic plans and performance metrics.
Facilitated successful cross-functional collaborations for the completion of key projects, fostering strong working relationships among team members.
Optimized resource allocation by conducting regular performance evaluations and providing personalized coaching for staff development.
Built high-performing teams through effective recruitment, onboarding, and talent development initiatives.
Cross-trained existing employees to maximize team agility and performance.
Maximized performance by monitoring daily activities and mentoring team members.
Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
Assisted in organizing and overseeing assignments to drive operational excellence.
Established performance goals for employees and provided feedback on methods for reaching those milestones.
· Deliver service level excellence, ensuring that all processes are governed under internal and external compliance and regulatory mandates
· Direct day-to-day operations, monitoring supervisors and application of staffing to ensure core needs are serviced and managed
· Ensure that quality, performance, productivity, and SLAs are met by the Department, and identifies areas for improvement, to gain maximum efficiency and optimum internal and external customer satisfaction
· Key contributor to development, oversight and monitoring of processes and for work queues and work folders, along with specific contract requirements
· Escalate issues prohibiting or restricting service standards regarding but not limited to technology, service standards, and productivity to department Director and appropriate naviHealth resources

Supervisor Clinical Operations

NaviHealth Inc.

03.2019 - Current

Monitor employees' day-to-day activities and made plans to rectify issues resulting in high performance.
Utilize monthly dashboards, quarterly reports, and other reports as needed to ensure end-user colleagues are executing daily work mandates as required to serve internal and external service levels and metric targets. This includes holding 1:1 performance management session's with colleague base.
Direct day-to-day operations at colleague level, assigning and coaching colleagues as needed, to ensure service level and quality standards are met.
Conduct weekly 1:1's with direct reports
Maintain knowledge about each health plan's requirements for data integrity along with CMS and NCQA requirements. Secure electronic medical record access and health plan portal access as needed.
Organize, plan, and prioritize daily work for assigned team to ensure adequate phone, fax, and correspondence coverage is available for all client contracts. This includes proactively managing scheduled and unscheduled time off.
Troubleshoot support staff technological issues prior to submitting tickets to naviHealth IT Help Desk
Participate in recruitment, interview, and hiring processes.
Maintain expert knowledge of all applicable client processes, contractual requirements, databases, compliance, data integrity, and security requirements.
Trained and guided team members to maintain high productivity and performance metrics.
Ensured colleagues adhere to daily performance metrics
Developed and implemented performance improvement strategies and plans to promote continuous improvement
Observed each employee's individual strengths and initiated mentoring program to improve areas of weakness.
Eased team transitions and new employee orientation through effective training and development.
Proved successful working within tight deadlines and fast-paced atmosphere
Managed team of 20 employees, overseeing hiring, training, and professional growth of employees

Manager Of Placement And Assessment

American Addiction Centers

01.2015 - 11.2018

Assured timely verification of insurance benefits prior to patient procedures or appointments.
Managed verification team of twelve employees
Managed doff shore India team of four
Monitor daily insurance verification queue
Found potential new hires and completing initial screens, interviews and tests.
Supported program operations by preparing and updating documents, reports and spreadsheets.
Conducted weekly team meetings
Trained team members, both in office and remotely.
Made contact with insurance carriers to discuss their policies and individual patient benefits.
Obtain prior authorizations and single case agreements
Created verification forms for medical and lab insurance verification
Responded to customer requests via telephone and email.
Counsel potential clients on insurance coverage concerns
Notified current call center staff of any changes in regards to insurance
Calculated financial responsibilities for clients admitting to facilities
Handled 20 calls per day to address customer inquiries and concerns
Improved operations through consistent hard work and dedication
Worked flexible hours; night, weekend, and holiday shifts
Managed on-site evaluations, internal audits and customer surveys

Training Facilitator

American Addiction Centers

01.2015 - 11.2018

Developed Insurance and Verification training programs.
Taught more than five classes or workshops per year.
Documented class activities, including attendance and participation, and provided feedback to management.
Created new lesson plans based on course objectives.
Mentored two employees per month after classes in order to monitor progress Insurance Verification areas.
Facilitated group sessions and provided one-on-one support.
Offered constructive feedback to employees under care regarding specific actions, behaviors and words.
Planned, implemented, monitored and assessed classroom instructional program.
Trained off shore India team of four.
Mentored 20 employees per month after classes in order to monitor progress in Insurance Verification.
Evaluated success of training programs and recommended improvements to upper management to enhance effectiveness
Taught more than 30 classes or workshops per year

Insurance Verification Specialist

American Addiction Centers

01.2015 - 11.2016

Made contact with insurance carriers to discuss their policies and individual patient benefits.
Accurately inputted all patient and insurance information into company's computer system using Salesforce
Assured timely verification of insurance benefits prior to patient procedures or appointments.
Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Assisted with correspondence, reports and special projects.
Served as primary liaison between clients and vendors.
Checked accuracy and integrity of files and resolved errors.
Calculated Usual, Customary and Reasonable (UCR) fees.
Called potential clients and explained insurance benefits
Reviewed 100 patient cases per week and verified insurance coverage information

Surgery Scheduler

Tennessee Orthopedic Alliance

07.2003 - 12.2014

Managed daily surgery schedule for 3 surgeons
Contacted patients to schedule any outpatient surgeries or procedures and tests.
Educated patients about surgeries and provided treatment plan documentation.
Coordinated with facilities to set up surgeries for outpatient surgery procedures
Reviewed medical histories and current information to provide accurate information to surgeons.
Verified insurance coverage and obtained pre-authorizations.
Confirmed accurate completion of forms/reports for admission, transfer and/or discharge of each resident.
Partnered with team of registered nurses to achieve overall well-being of all patients.
Routinely collaborated with department managers to correct problems and improve services.
Assisted in resolving and satisfying client requests and internal operational issues.
Reviewed customer survey information to prioritize areas of improvement.
Investigated and reported issues relating to patient care or conditions that might hinder patient well-being.
Assessed patients and documented their medical histories.
Documented patient information obtained from interviews.
Coordinated with facilities to set up surgeries for [3] Orthopedic Surgeons
Kept detailed records of office inventories and placed $500 orders for more supplies

Summary

Overview

Work History

Manager, Clinical Operations

Supervisor Clinical Operations

Manager Of Placement And Assessment

Training Facilitator

Insurance Verification Specialist

Surgery Scheduler

Education

Associates Degree - Healthcare Management

Skills

Timeline

Community Involvement

Community Involvement