Briana E. Johnson
Brandon,FL
Summary
Detail-oriented Medical Claims Processor with over six years of experience managing high-volume claims efficiently and accurately. Proficient in utilizing advanced claims systems such as QNXT, Facets, and Incedo. Skilled in analyzing and resolving complex claims issues, ensuring compliance with healthcare regulations, and improving operational workflows. Dedicated to delivering exceptional accuracy and service in fast-paced environments.
Overview
8
8
years of professional experience
Work History
Medical Claims Processor
MaryKraft Optum
01.2023 - Current
- Process behavioral health claims using Incedo with consistent processing rate of 12 claims per hour
- Ensure all claims are accurate and comply with organizational and regulatory standards
- Evaluated medical claims for accuracy and completeness and researched missing data.
Medical Claims Processor-Adjudicator
The Jacobson Group (HealthFirst)
01.2021 - 01.2023
- Resolved claim discrepancies, denials, and appeals, reducing average processing time
- Adjudicated 250-300 medical claims daily with high accuracy
- Ensured compliance with internal guidelines, policies, and healthcare regulations
Medical Claims Examiner
Cognizant (Horizon)
01.2021 - 01.2022
- Reviewed and adjudicated hospital and professional claims based on member records and policy contracts
- Utilized Facets to research and analyze claims for accuracy and policy alignment
Medical Claims Processor
SkyBridge Resources
01.2020 - 01.2021
- Entered and validated claim data with focus on completeness and accuracy
- Processed institutional and professional claims using Xcelys, ensuring timely resolution
Medical Claims Processor
Cognizant (Next Level Business)
01.2017 - 01.2020
- Processed high-volume claims for Cigna clients, managing complex scenarios involving pre-authorizations and out-of-network benefits
- Trained new employees on claims guidelines and adjudication processes
- Maintained timely and accurate claims processing workflow
Education
High School Diploma -
Armwood High School
Tampa, FL06.2011
Skills
- Critical Decision-making
- Proficient in ICD-10, CPT, and HCPCS coding
- Customer service
- Claim denial resolution
- Claims processing proficiency
- Expertise in QNXT, Facets, and Incedo claims systems
- Comprehensive understanding of payer operations
- Claims appeals and discrepancy resolution
Timeline
Medical Claims Processor
MaryKraft Optum
01.2023 - Current
Medical Claims Processor-Adjudicator
The Jacobson Group (HealthFirst)
01.2021 - 01.2023
Medical Claims Examiner
Cognizant (Horizon)
01.2021 - 01.2022
Medical Claims Processor
SkyBridge Resources
01.2020 - 01.2021
Medical Claims Processor
Cognizant (Next Level Business)
01.2017 - 01.2020
High School Diploma -
Armwood High School
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