Artisha Johnson
San Mateo HealthPlan
Rancho Cordova,CA
23
years of professional experience
Results-driven Medical Billing Specialist achieved reduced claim processing times through effective workflow strategies and ensured HIPAA compliance while maintaining high accuracy standards. Enhanced customer satisfaction by resolving issues promptly and communicating clearly, demonstrating strong analytical skills and comprehensive knowledge of insurance policies. Collaborated effectively within teams and adapted to evolving work environments, showcasing reliability and problem-solving abilities.
Work History
Claims Examiner II
1 Year- Reviewed claim information, supporting documentation, and case details, ensuring accurate processing and timely follow-up. Maintain organized records and update claim files with clear notes, status details, and required documentation. Communicated professionally with members, providers, coworkers, and internal departments, effectively answering questions and resolving issues. Use attention to detail to verify information, reduce errors, and support quality service standards. Follow established policies, procedures, and confidentiality requirements while handling sensitive claim-related information. Tracked open items, managed deadlines, and escalated complex cases for further review. Support team workflow by completing administrative tasks, responding to requests, and coordinating next steps across departments.
- Adjudicated medical claims using plan benefits, coding rules, and policy guidelines.
- Reviewed claim documentation to resolve discrepancies and ensure accurate payment decisions.
- Interpreted provider billing, procedure codes, and diagnosis codes for claims processing accuracy.
Medical Claims Examiner
1 Year 10 Months- Reviewed claims for accuracy and completeness, ensuring compliance with company policies and reducing potential rework. Processed insurance claims efficiently using electronic management systems. Processed a high volume of incoming claims in accordance with established policies and procedures. Verified claim data correctness in preparation for processing. Processed claims meet quality and production standards, implementing corrections to resolve identified issues. Collaborated with team members to resolve discrepancies in claim submissions, enhancing overall claim processing efficiency. Investigated discrepancies in claims to determine root causes and provide resolutions. Analyzed claim data to identify trends, leading to process improvements and better claim resolution strategies. Analyzed documentation to determine eligibility for benefits and services.
- Reviewed medical claims for coding accuracy, eligibility, and benefit compliance
- Adjudicated complex claims using plan policies, ICD, CPT, and HCPCS guidelines
- Investigated claim discrepancies and resolved processing errors with providers and internal teams
A/R Specialist
6 Months- Processed accounts receivable transactions with high accuracy, ensuring timely payment collection. Followed up on payers for timely resolution using IDX, Athena, and Epic; identified and corrected billing errors, collected payments, and resolved accounts. Initiated appeals and analyzed claim trends to reduce denials. Resolved customer inquiries on billing and payment issues, enhancing customer satisfaction. Collaborated with cross-functional teams to address and correct account discrepancies, streamlining resolution process. Worked in a contract position to support project goals.
- Managed accounts receivable aging, prioritizing collections efforts and resolving overdue balances.
- Reconciled customer accounts, identifying discrepancies and correcting billing errors.
- Processed incoming payments, applied cash accurately, and maintained updated ledger records.
Reimbursement & Contract Specialist
4 Months- Analyzed and reviewed accounts receivable aging report to collect what is owed, collected assets by ensuring timely and accurate follow-up. Managed all accounts, including Medi-Cal and Medicare payers. Tailored unique collections processes according to departmental guidelines. Coordinated billing, cash application, and pricing departments to secure payment on 1,000 patient accounts. Configured and loaded contract rates; performed network analyses to identify optimal provider partnerships. Identified potential contracting/service improvement opportunities. Negotiated and finalized contracts for primary, specialty, and ancillary services to ensure alignment with organizational goals and compliance. Supported contracting initiatives in various markets; amended contracts for regulatory compliance. Used Medicare and Medi-Cal fee schedule to determine correct payments. Negotiated Letters of Agreement with non-contracted physicians and ancillary providers. Developed targeted recruitment strategies to attract high-quality providers, improving service delivery in assigned markets. Interpreted Division of Financial Responsibility policies and procedures. Configured the Meditech system. Assumed a temporary contract role to support project needs. Drafted and reviewed contracts for compliance with company policies. Collaborated with stakeholders to clarify contract requirements and expectations. Analyzed contract terms to identify potential risks and ensure clarity.
- Negotiated provider and vendor contract terms supporting compliance with organizational policy and healthcare regulations.
- Reviewed agreements for accuracy, identifying inconsistencies in language, pricing, deliverables, and renewal provisions.
- Drafted, amended, and routed contracts through approval workflows using contract management systems.
Denial Specialist
1 Year- Analyzed denial claims for accuracy and compliance to ensure adherence to regulations. Reviewed and resolved accounts in work queue using Epic; processed denial claims daily in Epic Tapestry. Worked on old claims using Athena and IDX; daily focus consists of working complex denials across multiple payers such as Medi-Cal, Medicare, FQHC, and Managed Care, also used Medicare and Medi-Cal fee schedule to determine correct payments. Filed appeals and CIFs, followed up on claims to resolve contract discrepancies and clarify account balances. Worked on an A/R report to collect any monies owed. Resubmitted transplant claims for a hospital, including bone marrow, organ, kidney, and radiology. Identified trends in claim denials to streamline processes and mitigate future issues. Coordinated with clinical staff to collect documentation for appeals.
- Analyzed claim denials and routed accounts for timely correction and resubmission.
- Prepared appeal documentation using payer guidelines and supporting clinical records.
- Followed up with insurance carriers to resolve reimbursement delays and outstanding denials.
Billing & Claims Analyst
3 Years 5 Months- Processed electronic and paper claims for professional and hospital services, including dental, ophthalmology, behavioral health, radiology, and transplants, ensuring accuracy and timeliness of reimbursements through Amaysis and Cenpas. Collaborated with cross-functional teams to resolve complex claims issues, enhancing overall claims processing effectiveness. Analyzed claims data to identify trends and discrepancies, contributing to improved claims accuracy and compliance. Reviewed policy documents for compliance with regulatory standards.
- Analyzed medical claims for coding accuracy, eligibility, and benefit compliance
- Reviewed denied claims, identified root causes, and initiated appropriate adjustments
- Resolved provider and member inquiries regarding claims status, payment, and processing issues
Billing Manager
1 Year 5 Months- Managed billing processes for pediatric ophthalmology services and procedures. Coordinated with healthcare providers to resolve billing inquiries and disputes.
- Led billing workflows for pediatric ophthalmology claims, ensuring accurate coding, charge capture, and timely submission.
- Reviewed denials and reprocessed rejected claims using payer guidelines, EHR data, and billing system records.
- Coordinated insurance verification, authorization follow-up, and eligibility checks to reduce claim delays.
Billing Manager
1 Year 4 Months- Drove current accounts receivable to 92% from initial level of 46% in less than 8 months. Eliminated aged unidentified, unaccounted claims. I was Direct Management for 13 Patient Account. Representative and 4 Supervisor, I worked directly with CEO and CFO of the company on major projects such as creating an entire DME Company, performed monthly audits for all staff, provided uptraining for Department Supervisors, My department was responsible for A/R Tracking, 3rd party patient billing and all commercial, Medicaid and Medicare billing, Conducted monthly meetings with claims examiners from Department of Labor to ensure proper care for hospice patients. Oversaw, billing operations for pediatric ophthalmology services for pediatric ophthalmology services and patient accounts. Facilitated effective submissions of insurance claims for diverse ophthalmic procedures, ensuring compliance and accuracy throughout the process. Oversaw collection and reconciliation of payments for patient accounts and services rendered, enhancing financial accuracy and accountability.
- Managed medical billing workflows for pediatric ophthalmology services, ensuring accurate claim submission and timely reimbursement.
- Verified insurance eligibility and benefits, reducing coverage issues before patient appointments and procedures.
- Resolved claim denials by reviewing coding, documentation, and payer requirements for corrective resubmission.
Billing Manager
2 Years 1 Month- Managed billing processes for pediatric ophthalmology services, ensuring accuracy and timely reimbursements. Oversaw insurance claim submissions and follow-ups to maximize reimbursements. Coordinated patient billing inquiries and resolved discrepancies to enhance patient satisfaction.. Directed a team of three claims analysts to resolve billing and reporting setup requests across twelve divisions.
- Directed insurance claims processing, ensuring accurate submission and timely reimbursement.
- Oversaw accounts receivable workflows, resolving outstanding balances and reducing billing delays.
- Analyzed denied claims, corrected documentation issues, and resubmitted for payment approval.
Operations Manager & Billing Department Manager
8 Years 10 Months- Led a team of 24 Claims Representatives, oversaw daily center operations, Managed employee scheduling, payroll, and HR functions. Prepared management reports, analyzed data, and implemented policies that enhanced clinic performance. Held quarterly coaching sessions and annual performance reviews. Trained department supervisors in staff development and employee recognition strategies. I managed accounts to coordinate their overall functions of billing for professionals and hospitals. Maximized cash flow while improving patient, physician, and other customer relations. Oversaw efficient work processes and trained Claims Representatives and Coding staff. Oversaw claims quality reviews for accuracy, documented results, identified trends, and systemic root causes, and addressed issues with comprehensive background information. Researched and assessed status of professional and hospital claims to ensure alignment with contract provisions regarding high dollar amounts, claims aging, and pending values. Maintained records and reports. Managed staff scheduling to ensure adequate coverage for patient care. to ensure adequate coverage for patient care. Developed and implemented operational policies and procedures that improved clinic efficiency. Oversaw daily operations of behavioral health services, ensuring efficient service delivery. of behavioral health services and programs.
- Directed daily clinic operations, aligning staff workflows with behavioral health service standards.
- Supervised administrative teams, reinforcing scheduling accuracy and patient intake efficiency.
- Coordinated compliance activities, supporting HIPAA, documentation, and confidentiality requirements.
Education
High School Diploma
Associate of Science - Health Care Administration
Skills
Claims management
Record keeping
Customer service
Policy and procedure compliance
Claims follow-up
Issue resolution
Quality control
Issue resolution and escalation support
Time management
Microsoft Office suite
Team collaboration
Analytical problem-solving
HIPAA compliance
Workload management
Compliance regulation
Critical Thinking
Workload prioritization
Information validation
Timeline
Claims Examiner II
San Mateo HealthPlan
09.2025 - 09.2026Read More
Medical Claims Examiner
Chinese Community Health plan
06.2024 - 04.2026Read More
A/R Specialist
Eclat Health Solutions
12.2023 - 06.2024Read More
Reimbursement & Contract Specialist
Kaiser Permanente
07.2023 - 11.2023Read More
Denial Specialist
Alameda Health Systems
10.2021 - 10.2022Read More
Billing & Claims Analyst
Centene
11.2017 - 04.2021Read More
Billing Manager
Dr. Sam Sato Pediatric Ophthalmology
06.2016 - 11.2017Read More
Billing Manager
Victory Medical Solutions
02.2015 - 06.2016Read More
Billing Manager
Valor Hospice Care
01.2013 - 02.2015Read More
Operations Manager & Billing Department Manager
Richmond Behavioral Health Clinic
06.2003 - 04.2012Read More
Berkeley High
High School Diploma
Read More
Carrington College
Associate of Science from Health Care Administration
Read More