Precious Lynne Piega

Certified trainer to facilitate New Hire and Upskilling classes for a provider and member customer

services for Medicare and Medicaid process. This includes Member Customer Service, Provider

Hotline, and Claims Escalations.

● Facilitated small size (3 trainees) to a large training class size (40 trainees)

● Supported Operations through training initiatives

● Participated in enhancing the Operations-Training process by creating the End of Training Handoff Checklist and Guidelines that is now used by all Global accounts.

● Developed Trainers’ Interview Process and Trainer’s Assessment grid in recruiting or interviewing new hires. The creation of the tool helped the company hire more competent employees and has a 15% increase in retention rate. Created the Training Master List and Attrition list for the entire account and Login Tracker

● Mentored 3 SME-Trainers and prepared their development plan and executed this plan.

● Consistent top 5% Results Global Trainers.

● 2011 No. 1 Trainer for 3 quarters – Global Category

• Team Management & Leadership:
• Know, understand and immerse in the day-in-the-life of every single EA in your team and learn the SOP and processes of their tasks:
• Perform regular side-by-sides with EAs to understand their tasks SOP and execution procedures, and be capable of helping them with task-related questions.
• Act as a replacement EA when an EA is unable to perform duties.
• Manage the performance and growth of your EAs and set the bar high to achieve operational excellence:
• Monitor client-EA partnership health, intervening when there are performance/quality issues.
• Provide guidance to EAs in setting their goals and provide constructive feedback.
• Hold EAs accountable for their performance through difficult conversations as necessary.
• Work with EAs on their action plans and development plans from start until completion, and on multiple versions/iterations of their development plans.
• Provide regular coaching sessions to ensure that EAs feel connected to the Athena community, are set up for success, and reach their full potential.
• Basic Client Interface
• Perform regular facilitated feedback conversations with clients and EAs to understand areas for improvement of the EAs and to hold the two parties accountable on goals.
• Work with your EAs to come up with action plans based on the feedback sessions and mentor your EAs on how to report back, follow-through, and provide visibility to the client regarding the progress of the action plan.
• Reach out to clients during emergency situations, especially during times when the EA cannot report to work.
• Own EA and client escalations from start to finish:
• Attend, participate and contribute during meetings:
• Complete all administrative tasks:
• Track and reinforce your team’s compliance with surveys completion and the like.
• Check your EAs’ daily attendance, as well as their daily and weekly progress reports; surface red flags.
• Check and ensure that your EAs’ task journals and Loom Videos for task processes are complete and updated.
• Update all work trackers and reports.
• Facilitate filing of EA PTOs and OTs.
• Complete churn reports and all relevant reports and documentation on time.

• Plan and deliver a comprehensive training strategy for Getz Clinical Client users, staff, and channel partners.
• Produce training courses for the Learning Management System that educate participants on how to use and understand the Getz Clinical Connect products and modules.
• Develop alternative learning techniques and methods to address multiple learning needs of various users
• Maintains personal knowledge and awareness of current clinical practices
• Maintain the Getz Clinical education strategy and techniques to meet industry best practice
• Develop and deliver training to both internal and external system users for all new features, modules, and products developed by Getz Clinical
• Provide and support the ongoing education of channel partners so they are equipped to educate local users of the GCC system.
• Participate in continual product development and review to support New Product Innovation (NPI), providing expert clinical insight based on industry knowledge and providing relevant client feedback where appropriate during the product development planning meetings
• Conduct product demonstrations with relevant clinical input, to potential customers as a supplemental activity to presentations performed by Sales Team
• Conduct new feature demonstrations to existing clients as part of the scheduled release process and receive and process feedback into the product development lifecycle
• Undertake other duties commensurate with the nature and level of the role, under instruction from their manager

• Managed a team of registered pharmacists and nurses. Reported directly to Operations Managers and Operations Director.
• Provided weekly performance team report of the team handled focusing on the agreed KPI.
• Conducted weekly huddles with team and ensured that the new processes were cascaded and well understood by the team. Also ensured that the whole regional team was informed of the process updates through a cascade mechanism set in place. Worked closely with the Quality and Training team so all three pillars of operations were aligned with the processes.
• Conducted bimonthly coaching / OTO meetings with the team focused both on performance and behavior.
• Creates action plan to ensure that each team member reaches
• Works on escalations and other inquiries that require client review. Coordinates with our clients with the inquiries and cascade the correct approach with the inquired escalations and cases.
• Work closely with the regional leads to ensure that the teams are in alignment with the process and the team monthly QA Performance is above the target QA score.
• Works closely with the clients for any process updates, case requests and other process related enhancement. Maintains the Process Updates Tracker to ensure this is cascaded to the Regional Team.
• Attends to weekly client call to represent operations team and provide
• Work closely with other Regional Leads, Operations Manager and Quality Compliance Manager to ensure Conformance cases will be identified. This includes consistent monitoring of cases and calls and acting to any identified deviation of process.
• Monitors coaching compliance with all identified Non-Conformance and confirms completion of each action item in place.
• Creates SME / Super User Development plan and Development activities to ensure professional growth and process enhancement. The Super Users are guided accordingly and develop them to be future leads.
• Develops processes such as Notification Process, Non-Compliance Process and Coaching process which helps in a more systemized operation.

● Managed a team of 8 USRN nurses as clinical advisers. Reported to the Chief Executive Officer and Chief Operations Officer of the nursing home clients and Chief Executive Officer of the account.

● Collaborated with the Chief Operation Officer and the Facility Managers for all the nursing home

clients’ staff training needs and process improvement plans based on the identified clinical and compliance risks

● Clinical Risk Assessment of all the assigned residents via various electronic systems/platforms. Identified all possible clinical and standard compliance risks.

● Created deep dive clinical analysis of the facility’s clinical risks and quality issues that may result in noncompliance with the Accreditation Standard of the Australian Government.

● Maintained and ensured the accuracy of the monthly KPI report of the nursing home clients.

● Improved existing Facility SOPs and policies and procedures of the facility. Included creating SOPs, Work Instructions, and Rolling out onshore training and toolbox talk to the Facility Staff.

● Provided daily updates of the teams’ performance and Weekly team progress to the client CEO and COO.

● Created and Improved the SOPs, Report Template, Training Materials, and Job Aids of the team.

● Worked closely with Quality and Compliance Officer to identify the team’s Quality Status and identify learning needs and improvement of the clinical team. This included their weekly Quality coaching and feedback sessions, reinforcement training classes, and development of Job Aids.

● Supervised 2 USRN teams under different Line of Business. The first team included 18 nurses from the Concurrent Review Process and 7 nurses from Discharge Planning Process. This also included coordination with 2 Process trainers and 2 Quality Analysts.

● Provided individual weekly performance coaching and feedback to the team members.

● Performed Weekly Team Root Cause Analysis and Error Trends Report to enhance the quality performance of the teams.

● Ensured that metrics / KPI assigned to the team were met and expected results were delivered.

● Collaborated with the Training and Quality team in improving the reviews of our nurses and to address error trends, and process and training Gaps.

● Delivered daily operations report such as End of Day Reports, Case Assignment, Daily Concurrent Inventory, End of Day Quality Reports, and Staffing Assignment to onshore stakeholders.

● Manage the team’s Inventory and Productivity. Ensured that the cases met the expected turnaround time.

● Delivered weekly report for the Leadership and Weekly Management meeting for the onshore stakeholders and leadership.

● Participated in various client calls and represent the team in the performance discussions and concerns

● Maintained good client relationships with the onshore stakeholders. Worked closely with onshore leadership in maintaining quality reviews and maintaining compliance with NCQA and CMS standards.

● Worked closely with medical directors for the cases that required secondary reviews.

● Maintained facility assignment for the 105 assigned facilities in New York to the two teams.

● Performed daily huddles with the team focusing on the team’s Productivity, Quality Error Trends, Process Updates, and other operations reminders.

● Planned and executed a career development plan for each team member, identifying possible Future leaders. This includes enhancing both their review and leadership skills.

● Mentored the team’s SME (Subject Matter Expert).

● Completed Performance Evaluation and monitored individual progress.

● Supervised a team of 20 US-licensed nurses as Claim Nurse Reviewers which reviews both inpatient and outpatient claims. Utilized MCG or Milliman Care Guideline as the core guidelines of the review.

● Worked closely with medical directors for cases that required secondary reviews.

● Provided performance weekly feedback to the nurses.

● Performed root cause analysis to effectively-identify gaps.

● Delivered the following Operations Reports: Daily End of Day Report, Weekly Operations Dashboard, Daily Team Inventory Report, Nurse’s Scorecards, Staffing Report, and Team Lead’s audits, Error Logs, and Analysis and Individual Performance Plan.

● Assisted the Shift Manager in preparing for the monthly client billing or invoice.

● Worked closely with the onshore Quality Coach Team in enhancing and strengthening the team’s

Clinical review skills by providing audit feedback, real-time coaching, enhancement training, and

case study/case discussion.

● Led team huddles and other initiatives to improve both productivity and quality performance of the team

● Served as subject matter expert for the team. Reviewed escalated cases.

● Participated in various Operations and Training / Quality Calls. These calls include the weekly inventory and Medical Director Meeting, and Quality Calibration.

● Reviewed cases to be abreast of the process and help with team productivity. This also includes

responding to client escalation and review inquires. Also performs team lead’s audit apart for the

Quality Department audits, to have a higher hold of quality control.

● Coordinated closely with HR for any HR-related concern of the team.

• Facilitated New Hire and upskill training classes for clinical and non- clinical Medical Claims Review (Retrospective Review) for Philippine and US-based nurses. Certified trainer for both Clinical and Non- Clinical MCR.
• Led the launching of MCR in Manila together with the Operations Manager. This included hiring nurses, training preparation, and development of the training curriculum, precept the 22 newl trained trainees until they pass the precept phase metrics, and be fully endorsed to operations.
• Follow up the newly trained nurses for 8 months during the ramp period until the team reach full steady-state.
• Audited and Precept all MCR training both Philippine and US-based nurses. This included performance feedback, coaching, root cause analysis identification, and performance management.
• Led all MCR training related calls.
• Assisted in launching the MCR Team in Manila. Participated in the hiring process, train development of the account, and identification of process improvement until a steady state.
• Enhanced training materials and curriculum.
• Created tools and other initiatives that helped the business. Created the Clinical Quality Audit Tool used in auditing the completed claims for MCR Nurses, training decks, and Case Sample bucket that houses various case samples to be used for training. The Quality Audit Tool paved way for an 18 improvement in quality and shorten the ramp period from 9 months to 6 months due to more focused coaching and better quality scores.
• Consistent STAR Awardee for UHG Training Team for the year 2013 and 2014. Also received the “STAR Sustaining EDGE Award” for the 1 st quarter of 2014. Recognized for Service Excellence Award For OPTUM 2 nd and 3 rd Quarter 2014