Summary
Overview
Work History
Education
Skills
Training
Qualifications Summary
Timeline
Generic

BERNICE JOHNSON

MONROE,MICHIGAN

Summary

I am a highly motivated professional with over 24 years of experience at Blue Cross Blue Shield of MI. Seasoned professional with exceptional customer service and research skills. I can work under pressure as an integral team player and outstanding liaison skills. My focus is to maintain a career which allows for continued growth; where I can reach my full potential utilizing my business experience and advancing my education, skills and technical knowledge.

Overview

29
29
years of professional experience

Work History

Analyst Medical Review and Appeals

BCBSM
01.2009 - 04.2025
  • Lead, plan and coordinated assigned activities; provide technical and administrative support to 3 management and 15 staff. Identify and/or analyze business problems and assist with the resolution of the problems.
  • Communicate result of analysis in detailed, timely, error free manner
  • Participate in Process Improvement, demonstrate knowledge and apply NCQA standards relevant to responsibilities in Medical Affairs
  • Monitor quality measurements for NCSW, MR&A Mailbox and Fax box and the electronic medical review platform
  • Interface with internal and external areas of the corporation in issue resolution including leadership and medical consultants
  • Updated AIM Error Report Daily to ensure rejected claims codes are corrected
  • Produce monthly metric reports for department and Key stakeholders
  • Create and maintain SharePoint sites
  • Develop and manage work processes for department

Technician- Medical Review and Appeals-Policy Development

BCBSM
01.2007 - 05.2009
  • Assist team leaders and managers with special assignments, retrieve data and prepared reports and analysis
  • Developed communication job aids and computer presentations
  • Interface with internal and external areas of the corporation in issue resolution
  • Increased customer satisfaction with prompt and knowledgeable support for various technical issues.
  • Performed troubleshooting and diagnosis on malfunctioning equipment.

Administrative Assistant - Quality Assurance/General Groups

BCBSM
10.1996 - 12.2007
  • Provide technical and administrative support to frontline Supervisors and Director
  • Provide technical and administrative support of Customer Service professionals
  • Develop and manage work processes for department
  • Represent department on various work groups
  • Supported executive staff through scheduling meetings, coordinating travel arrangements, and preparing crucial documents.

Education

Bachelor of Business Leadership -

Baker College Flint MI University
Flint, MI
03.2008

Associates Degree - Business Administration

Baker College
Flint, MI
06.2005

Skills

  • BCR Tool Inquiry Tool
  • EOS Thin Client
  • Ingenix Encoder Pro
  • SharePoint
  • NCSW
  • MOS
  • Local / IRIS
  • Content Manager
  • Benefit Explainer
  • TPX 3270 NASCO
  • MS Excel
  • Administrative skills
  • Process development
  • Work group experience
  • Analyzing reports
  • Quality reports
  • C2D2 WDM reporting tool
  • Handling PHI
  • Creating communications
  • Excel
  • PowerPoint
  • Word
  • Visio
  • Outlook
  • Diversity and Inclusion Coordinator
  • Analytical problem solving
  • Research and analysis
  • Time management

Training

  • Diversity - Developing Your Leadership Skills
  • Fundamental of Organizational Learning
  • Problem Solving - Determining and Building Your Strengths
  • Culture and Its Effect on Communication
  • Health Care Value Town Hall
  • Diversity Learning Labs
  • Diversity and inclusion Coordinator

Qualifications Summary

I am a highly motivated professional with over 24 years of experience at Blue Cross Blue Shield of MI. Seasoned professional with exceptional customer service and research skills. I can work under pressure as an integral team player and outstanding liaison skills. My focus is to maintain a career which allows for continued growth; where I can reach my full potential utilizing my business experience and advancing my education, skills and technical knowledge.

Timeline

Analyst Medical Review and Appeals

BCBSM
01.2009 - 04.2025

Technician- Medical Review and Appeals-Policy Development

BCBSM
01.2007 - 05.2009

Administrative Assistant - Quality Assurance/General Groups

BCBSM
10.1996 - 12.2007

Bachelor of Business Leadership -

Baker College Flint MI University

Associates Degree - Business Administration

Baker College

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BERNICE JOHNSON