Lydia Good
Phoenix
Summary
Results-driven management professional with proven ability to lead teams to success. Strong focus on team collaboration, operational efficiency, and achieving measurable outcomes. Adept at strategic planning, process improvement, and fostering culture of accountability and excellence. Known for adaptability and consistently meeting changing organizational needs.
Overview
16
16
years of professional experience
Work History
Manager, Peer to Peer
United Health Group
04.2016 - Current
- Provide Manger support to Peer-to-Peer Scheduling teams for Behavioral Health, Cancer Specialty Guidance Program and Legacy M&R, E&I and C&S plans.
- Oversee1 Supervisor and2 Team Leads,45 Front Line Direct Reports
- Responsible for New Hire recruiting, interviewing, candidate selection and onboarding training for Peer to Peer
- Work with a Workforce Management team to ensure staffing levels are adequately met to ensure department goals can be met daily
- Set and track individual team business goals to ensure standard of Meets Expectations in obtain by each employee for end of the year review
- Coach, provide feedback and guide others, acts as a resource
- Ensure department productivity and performance metrics are met to ensure compliance with CMS and State regulated guidelines
- Work directly across many departments and cross functional teams to design, develop and drive successful deployment of new and enhanced programs and services
- Adapt departmental plans and priorities to address business and operational challenges
- Determine appropriate department success metrics with which pilots and / or current peer to peer processes will be evaluated
- Identify solutions to non - standard requests and problems
Clinical Administrative Supervisor, Intake
United Health Group
05.2012 - 04.2016
- Supervise team of17 Intake Coordinators who are telecommuters and onsite staff
- Includes managing HR functions such as approving timecards/payroll bi-weekly, monitoring and recording of daily/monthly attendance and monitoring of daily/weekly/monthly performance metrics & scheduling
- Mentoring and coaching of Intake Coordinators to ensure performance metrics are met and to ensure dept
- Production goals are met
- Assuring agent adherence to schedules through Workforce Management IEX
- Specifically ensuring team is compliant with end-to-end Intake processes and ensuring accuracy with the data entry of Intake case creation
- Assisting downstream partners with research on possible case errors by Intake
- Assigned to CMS remediation efforts to include reporting and tracking of errors that may cause or lead up to a missed TAT or Out of compliance case
- CMS Remediation efforts consist of working the HCE Defect Report daily & ECAR reporting daily
- Assigned to monitoring the Notification Resolution mailbox for provider advocate inquiries on potential data entry errors causing claim denials
- M&R Intake SME for UHG CMS Internal audits
Clinical Administrative Coordinator, Intake
United Health Group
05.2009 - 07.2012
- Assisting management team as back up for MRL (Medicare resource line) coverage to assist call center agents
- Assigned to numerous special projects at management’s request –Care Core Radiology spreadsheets, Health Net migration to Secure Horizons & Right Fax faxes
- Assisting providers with prior-authorization requirements per Medicare guidelines
- Providers to include hospitals, snfs, ltacs, airs, ambulatory surgical centers, ambulance transport providers, Home Care Services and DME providers
- Assisting providers with prior-authorization status and coverage determinations
- Coverage determinations to consist of approvals, denials per Medicare guidelines, clinical information requests by review team, options for appeals consideration
- Data entry and verification of ICD-9 & CPT codes
- Documenting & data entry of all inpatient/outpatient services depending on providers network status with UHC
- Verifying and data entry of member demographics
Education
No Degree - Mass Communication
South Plains College
LevellandSkills
- Knowledgeable in platforms such as ICUE, Citrix/CareOne/OCM/Aerial/MAC
- Proficient knowledge in NICE IEX WF Management & CMS Supervisor
- Medicare & Retirement Plans, Employee & Individual plans, Community & State Plans
- Respond well in a high-pressure atmosphere Proficient administrative skills, such as data entry,10 key, type60 wpm, MS Windows XP Professional, MS Power point, MS Word, MS Excel, MS Outlook and Internet
- Strategic Planning, Delegations and Decision making, Data Analysis, Conflict Resolution
Timeline
Manager, Peer to Peer
United Health Group
04.2016 - Current
Clinical Administrative Supervisor, Intake
United Health Group
05.2012 - 04.2016
Clinical Administrative Coordinator, Intake
United Health Group
05.2009 - 07.2012
No Degree - Mass Communication
South Plains College
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