Summary
Overview
Work History
Education
Skills
Additional Information - Responsibilities
Qualification Summary
Timeline
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Christina Johnson

Data And Reporting Analyst
Elkton,MD

Summary

Data-driven Reporting Specialist with 15 years of experience in Healthcare related data mining, data analysis, strategic planning and developing reports.


Proven track record of successfully managing over 80 post-payment recovery projects working directly with senior leadership, Clients, and hospital billing management teams during audits.

Skilled in utilizing tracked results to aid in the development of business solutions and best practices in generating and customizing reports with varying complexity and expertly gathering, organizing, and disseminating significant amounts of information with attention to detail and accuracy..


In all, over 20 years of healthcare healthcare experience specialized in Governmental and Commercial Medical Billing and Reimbursement processes including full life cycle claims expertise within billing, appeals, claim’s payment, denials, and post pay auditing

Overview

21
21
years of professional experience
1
1
year of post-secondary education

Work History

Lead Data and Reporting Specialist

Indepence Blue Cross
Philadelphia, PA
01.2019 - Current
  • Use Tableau and PowerPoint software to generate reports providing insight into areas to target based on specific health concerns identified through data analysis.
  • Export and convert raw medical claims and referral data from multiple database servers and applications to extrapolate data into usable reports.
  • Analyze reports, data requirements and parameters, to determine best technology solution, format and distribution method.
  • Collaborate with business-unit leaders to identify target areas to prioritize potential opportunities or areas to improve performance. Analyze financial trends to provide detailed financial reports to management.
  • Synthesize and interpret relevant post payment claims data to generate monthly PowerPoint presentations of current and historical client engagement information.
  • Regularly create various Excel documents to assist with pulling metrics data and presenting information to stakeholders for concise explanations of best placement for needed resources.
  • Produced monthly reports using advanced Excel spreadsheet functions for over 100 team members.
  • Develop required policies and procedures that reflected actual goals, tasks and workflows, while meeting all regulatory compliance requirements.

Business Operations Analyst

AmeriHealth Caritas
Philadelphia, PA
04.2015 - 12.2018
  • Handled project management for 2 projects, managing 10 team members from various departments to redeploy online process for submitting internal inquiries for business enhancements.
  • Restructured various reporting deliverables and contract changes processes through coordination with compliance director to create and execute projects.
  • Reviewed internal systems and organized training plans to address areas in need of improvement.
  • Designed internal dashboard for at-a-glance system and project status monthly reporting for directors and senior leadership.
  • Contributed to annual budget preparation by providing variance reporting and analysis.
  • Compiled research data and gave professional presentations highlighting finds and recommended optimizations.
  • Developed and enforced policies and procedures for compliance with company policies.
  • Assisted directors with special projects and ad hoc reporting requests.

Business Operations Analyst (Team Leadership)

AmeriHealth Caritas
Philadelphia, p
04.2015 - 12.2018
  • Gathered information to identify any system or process related issues and seek timely, reasonable solution
  • Lead team of 5 independently to meet departmental objectives, contract changes, and system updates.
  • Provided Operational support by managing, tracking and reporting on team projects and tasks through completion
  • Collaborated with various departments to streamline workflows and optimize resource utilization.
  • Evaluated current processes to develop improvement plans.
  • Managed cross-functional projects to ensure timely delivery of high-quality results.

Vendor Management Business Analyst

AmeriHealth Caritas
04.2015 - 12.2016
  • Lead analyst and point of contact for testing claims submission requirement changes, review and audit data, creating new process guidelines, present analysis findings, document processes and procedures and informed management of significant issues on 7 projects.
  • Effectively worked as project lead among 18 vendors and stakeholders, to elicit, analyze, communicate and validate new business healthcare billing requirements and contracts.
  • Primary contact for vendor-related claims processing, develop process improvement solutions
  • Traveled to Vendor location to assess their processes and identify potential areas for improved processes on site.
  • Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
  • Collaborated with stakeholders to define project objectives and criteria.
  • Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
  • Supported software development projects by defining clear requirements and effectively communicating them to technical teams.

Compliance Auditor/Analyst - Contract Compliance

Connolly, Inc.
04.2011 - 09.2014
  • Lead team of ten responsible for auditing healthcare claims through data mining, medical records and contract review, providers across 27 states.
  • Created weekly and monthly reporting of audit financials, overpayment recoveries received, outstanding balances due, in addition to suggested contractual adjustments needed for cost savings.
  • Conducted monthly client calls to review audit financials, identify “issue” audits, suggested process improvements to move audits forward towards recoveries and resolution.
  • Strengthened client relationship by providing detailed audit findings to modify contracts during renegotiation to mitigated overpayment of medical claims.
  • Developed and maintained training materials used for audit staff to clearly identify audit processes, guidelines and procedures
  • Developed and maintained “Audit Process” document used for all audits submitted to walk providers and client through audit processes.
  • Worked with client's legal team through litigation process on overpayments identified.
  • Tested new system tools and reviewed assumptions during system creation and after its release

Junior Auditor

Connolly, Inc.
02.2010 - 03.2011
  • Reviewed medical claims paid through data mining to determine if potential overpayments occurred
  • Conducted audits remotely by reviewing invoices and itemized bills requested from providers
  • Identified over 4 million dollars in overpayments from concept specific criteria/guidelines including, but not limited to maternity stays, contract carve-out for high cost drug reimbursement, contract carve-out allowed per diem reimbursement
  • Identified over 4 million dollars of implant and high cost drug overpaid claims via contract and medical records review.
  • Worked with provider to secure overpayments identified then requested.
  • Provided detailed analysis of audit findings to provider and client

Medical Claims Adjudicator

MedRisk
02.2009 - 01.2010
  • Review UB and HCFA claims for accuracy, ensure consistency, verify charges, process packages, resolve insurance problems
  • Ensured bill dates of service and modalities are consistent with diagnosis and global fees assigned per contracts.
  • Verified total charges and balancing charges once keyed/billed
  • Timely and accurate resolution of all insurance problems from inaccurate or incomplete billing
  • Processed packages in received order based on priority.
  • Reviewed and submitted for payments 50 claims per day as required.
  • Proactively analyzed, identified and resolved process issues

Reimbursement Consultant

Deloitte and Touche
06.2007 - 02.2009
  • Commercial insurance billing, prepare and submit claims, work with insurance companies, analyze and improve processes
  • Developed strategic partnerships with key stakeholders to ensure optimal reimbursement rates were achieved for clients.
  • Worked on site for two clients to assist in complex claims submissions.
  • High Volume Commercial Insurance Billing for Home Health Care
  • Prepared and submitted claims through Scrubbing system, online and paper billing
  • Billed for Operating room Procedures, Emergency Visits and Workers Comp Claims
  • Assisted in analyzing process to improve timeliness of claim submission and subsequent adjudication
  • Worked closely with insurance companies on correcting and resubmitting third party billing

Medical Biller

USBioservices
03.2003 - 10.2006
  • Accurately billed claims, reviewed medical charts, processed claims, worked independently and with teams to handle denials.
  • Maintained compliance with industry regulations by staying updated on changes to medical billing codes and requirements.
  • Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
  • Reviewed outstanding balances owed by patients; initiated collection actions if necessary resulting in improved account recovery efforts.
  • Resolved discrepancies in accounts receivable reports, contributing to improved cash flow management.
  • Negotiated favorable payment terms with third-party payers, improving overall revenue collection rates.
  • Kept abreast of commercial and governmental payer rules
  • Delivered timely and accurate charge submissions.

Education

Bachelor of Science in Data Analytics -

Southern New Hampshire University
Hooksett, NH
02.2023 - Current

Skills

Microsoft Excel

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Additional Information - Responsibilities

  • Create departmental reporting templates for 100+ staff to use and track productivity.
  • Create monthly, quarterly, and yearly reports for leadership utilizing PowerPoint, Excel and Tableau.
  • Work with mangers and directors to create appropriate audit documentation
  • Obtain feedback from management to create specific reporting and documentation based on departmental goals
  • Perform data mining on large datasets of member and claims information.
  • Identify trends and patterns in data to provide insights and recommendations for improving business performance and decision making.
  • Implement data quality measures and ensure accuracy and reliability of data used in reporting.
  • Collaborate with IT team to ensure data accuracy and data integrity in reporting systems.
  • Provide guidance and support to team members in effectively utilizing data analysis tools such as Tableau, PowerPoint, SharePoint, Access, and Excel.

Qualification Summary

  • Over 20 of healthcare experience specialized in Governmental and Commercial Medical Billing and Reimbursement processes including full life cycle claims expertise within billing, appeals, claim’s payment, denials, and post pay auditing.
  • Over 14 years of compliance audit and analysis experience via raw data analysis, data mining, itemized bill and invoice review.
  • Three years of Home Infusion claims coding, billing and collections experience
  • Over four and a half years specialized in provider contract compliance auditing of post payment claims
  • Responsible for identifying over $40M in overpayments as a post payment recovery auditor.
  • Over 12 years of employee training and coaching experience
  • Over 14 years of leadership, staff work assignment and quality review experience
  • Over 14 years of reporting to key stakeholders and management

Timeline

Bachelor of Science in Data Analytics -

Southern New Hampshire University
02.2023 - Current

Lead Data and Reporting Specialist

Indepence Blue Cross
01.2019 - Current

Business Operations Analyst

AmeriHealth Caritas
04.2015 - 12.2018

Business Operations Analyst (Team Leadership)

AmeriHealth Caritas
04.2015 - 12.2018

Vendor Management Business Analyst

AmeriHealth Caritas
04.2015 - 12.2016

Compliance Auditor/Analyst - Contract Compliance

Connolly, Inc.
04.2011 - 09.2014

Junior Auditor

Connolly, Inc.
02.2010 - 03.2011

Medical Claims Adjudicator

MedRisk
02.2009 - 01.2010

Reimbursement Consultant

Deloitte and Touche
06.2007 - 02.2009

Medical Biller

USBioservices
03.2003 - 10.2006
Christina JohnsonData And Reporting Analyst