Catherine Baldwin Email & Phone Number

Florida, United States

Tampa/St. Petersburg, Florida Area

• Successfully led a 365-day Call Center Operation team of 84 associates, including permanent and temporary employees, across 3 locations for 29 states completing 5 different types of Medicare appeals required to be.
• Reduced Average Hold Time (AHT) and Average Talk Time (ATT).
• Implemented monthly Call Auditing and Supervisor 1:1 meetings.
• Created production and quality metrics to improve overall Call Center productivity which included measuring CSR status (Available, Unavailable, Abandonment Rate, Hold Times, Transfers, Talk Time).
• Created and implemented templates for COB Reports, Nightly Assignments and a Weekend Checklist for rotating Supervisor Coverage to ensure all areas of responsibility were effectively staffed to meet compliance.
• Created automated daily reports of pending volume for data entry and letters to allocate staff appropriately.

Tampa, Florida

• Created UM, CM and Appeals Team within 60 days to manage transition from previous company. Results:
• Developed Business Rules to transition Medicare health plan with 7,300+ membership from outgoing team to ensure all aspects were properly managed and regulatory compliance was met.
• Participated in ODAG audit for UM and Appeals work after having completed reporting requirements.
• Created manual appeals tracking system for 150+ requests received per month when go-live of medical management significantly delayed.
• Completed process for Health Assessment Tool (HAT) member mailings for population of 7,300+. Additional mailings included Asthma, COPD, Diabetes and Advanced Directives information.
• Developed step actions for UM and CM processes.

Tampa/St. Petersburg, Florida Area

• Managed team of 71 associates and 4 Frontline Leads performing in a production-based environment for all areas of job performance including interviews, annual performance review, coaching and terminations.Implemented.
• Increased overall staff production by 25%.
• Reduced Stay Healthy team overall decline ratios from 24% to 14% by providing “Rolling with Resistance” trainings.Implemented RIT Effectiveness:
• Reduced UTC inventory lifecycle from 12+ months to 30-day turnaround.
• Reduced RIT Managed inventory from 5% to 0.3%.
• Retained more members in Humana At Home Care Management.SNP Outreach Improvement:

Seattle, WA

• Developed Performance metrics for claims reviews and authorizations:
• Increased productivity metrics by 50%.
• Established productivity metrics to be reviewed monthly.Improved authorization turnaround time:
• Created policies for workflow processes.
• Created SharePoint site for standardization. Leader of staff delivering high quality, cost effective care management workflow to 320,000+ State Medicaid recipients. Ensure compliance objectives are met for state.

Tacoma, WA

Complete daily coding audit review of ICD-9 and CPT code selection, sequencing and modifiers. Perform coding audit on physician Evaluation and Management services to ensure documentation requirements meet level of service guidelines.

Tacoma, WA

• Increased employee knowledge area of expertise by 34% by providing cross training, reference tools, and continuing education.
• Provided education to employees in all aspects of job performance related to referral and authorization processing. Training including system changes, Desk Procedures, Policies, ICD-9, CPT and HCPCS.
• Provided URAC accreditation training to ensure company’s compliance with quality standards.
• Analyzed weekly quality reports for 24 employees to track and trend issues and addressed ongoing training needs through continuing education.
• Planned and created structured training schedule for new employees. Overall results directly improved new hire efficiency in the first 90 days.
• Created and tracked interactive training guides to increase knowledge base of employees.

Associate Of Arts And Sciences (Aas)

Certificate