Adrienne E. Johnson

• Began employment as an Intake Notification representative in March 2004:

This entailed answering incoming lines to

process notifications for medical care.

Verification of eligibility information

including policy requirements regarding

notifications for certain services. Once all

required information was input, transferred

cases to the corresponding queues for

further review.

• Interviewed and was selected to become a Clinical Coverage Review Coordinator:

In this position, I reviewed and triaged

cases for proposed services. If the

necessary information was not available, I

contacted the requesting physician’s offices

for further clinical information. Once I

reviewed the member’s policy information,

as well as applicable state and federal

mandates, I would either make a coverage

determination or transfer the case to a

Medical Director for further review.

• Served as the department's Preceptor/Team Lead:

In this capacity, I was the resource contact

person for staff that had questions or

concerns about policies and procedures

I was then selected as Pre-Service

Supervisor and served in that role for 4

years

• Served as Intake Manager:

In this role, I led a team of 56 direct

reports and 3 Supervisors under my

hierarchy. I conducted weekly CMS

required audits for our Medicare and

Retirement line of business under

UnitedHealthcare West. These audits

include groups under Capitated and

delegated provider groups, and I provided

these representatives with feedback on a

monthly basis. I administered and

assembled inventory reports for our entire

department twice weekly to ensure that

we were in compliance with Department

of Insurance and Department of Labor

guidelines. I conducted monthly staff

meetings to keep the lines of

communication open and ensure that my

team was consistent in processes.

• My current position is Associate Director for the Quality Performance and Consumer Experience & Compliance with the National Letter Team (NLT):

I have served in this role over 9 years. I

assist senior leadership in managing all

aspects of operations. I manage and

approve process changes and project

improvements that apply to the Quality

Review Nurses and Training staff under

the NLT hierarchy. Oversight of the training

program is inclusive of all lines of

business, including the development and

design of training documents and

materials. I communicate on a daily basis

with other departments to ensure all

partnerships work hand in hand to deliver

the best outcome to our members. I attend

and participate in multiple audits on behalf

of the team to relay any process

clarifications and be available to discuss

specific cases (typical number of audits/year

26-30 and, at times, they take place

concurrently). In this capacity, I also oversee

new business, RFPs, Expansions,

Regulatory Changes/requirements and

migrations, as well as Pre- and Post-

Implementation projects for the NLT.

I ensure any recommendations/findings from

regulatory entities and or clients are

implemented in the operations through the

collaboration of the operational leaders.

I assist in developing and implementing

plans and goals for the department. I

monitor and evaluate operations,

corresponding policies and contracts,

department tools and resources to ensure

efficiency and applicability. In addition, I am

responsible for interviewing, hiring and

coordinating the training of new employees

to my team. I am able to interface with so

many other departments both internally and

externally to help to make the healthcare

system work most efficiently especially for

our members and providers.

• I started as a Beneficiary Services Representative in the Central Call Center
• This position entailed answering beneficiary inquiries regarding general customer service and enrollment issues, explaining Tricare policies and programs, and researching medical claims issues
• Within a 10 month time span, I interviewed and was selected for the Customer Service Team Lead position
• In this position, I lead a team of 12 representatives
• I assisted with the management of the daily operational activities of the entire call center, including monitoring of telephone queue coverage using the Avaya system, organized team meetings, assisted in training of all call center employees, and answered all difficult/escalated calls
• I also answered Customer Service Representatives calls through an internal help desk to research complex issues
• I am able to complete multiple tasks in a timely manner under minimal supervision

• I answered incoming lines in regards to customer inquiries, account set-up, tracking packages, and scheduling pick-ups and deliveries
• Using the PC, Internet and Intranet, I serviced accounts and typed many on-line forms to send to FedEx hubs all across the United States