Deondra L. Johnson
Columbia
Overview
18
18
years of professional experience
1
1
Certification
Work History
Program Coordinator II
SCDHHS
09.2023 - Current
- Responsible for review and approval of all Medicaid provider submitted EFT change requests. Using most current industry standards and SCDHHS policies and procedures, reviews and assesses EFT change requests to determine validity and accuracy. Works with Medicaid provider enrollment vendor via document repository system to communicate and route work requests and approvals.
- Responsible for processing Medicaid provider applications that require SCDHHS handling. This includes both initial applications and revalidations. Works with provider applicant and internal areas to facilitate review and approval of Medicaid provider enrollment applications ensuring that agency goals and published timelines are met. Serve as subject matter expert able to field questions and assist internal stakeholders in all matters related to Medicaid provider enrollment.
- Demonstrate a knowledge of relevant policies and procedures that impact provider application processing, contract, claims adjudication reimbursement and general inquiry and escalation decision points. Identify potential conflicts and share information with team and supervisor to eliminate delays and need for additional processing steps. In addition, adhere to management policies and procedures, business process improvement, and performance requirements within guidelines.
- Meets professional development goals as assigned by management. Participates in cross training opportunities. Coordinates the creation of individual professional development plan with manager. Monitors progress toward continuing professional development.
- Performs other duties as assigned adhering to all program, agency, State and other related policies, procedures, privacy and timeline standards.
Operations Analyst (Medicare)
PGBA
11.2022 - Current
- Evaluate existing procedures and processes to make recommendations for improvement. Monitor reports to assess the impact of performance on key measures. Provide reports and/or analyses of internal performance metric for various projects as well as for individual performance against those metrics.
- Assist in the implementation and maintenance of systems or processes to include testing. May manage and relay the purpose, scope, and status of each implementation to management.
- Develop and maintain written procedures within departmental and organizational standards. May document and streamline automated procedures into end-user training material.
- Conduct workflow and process audits of staff and reference materials as needed. Work with staff and manager to research and document errors, progress, performance, or other metrics to assess efficiency. Provide training for new employees and ongoing training as workflow efficiencies are revised.
- Generate data to prepare reports and maintain databases and/or requests reports on specific statistics in order to analyze trends. Maintain area reports. Quality check records affecting accuracy of reports by researching and testing processes and methods.
- Maintain close contact with management to provide updates on any issue/projects. Complete special projects and informs management of any trends or changes in statistical reports. May serve as liaison between the department and other internal/external groups.
Benefit Files
Blue Cross & Blue Shield
02.2013 - 08.2024
- Works closely with analysts and team members to understand benefit plan designs and business requirements.
- Based on approved design solutions, programs and/or performs quality control audits of specific benefit data structures, RULEs, reports, and/or testing scenarios utilizing enterprise server (Benefit Files, RULEs, AMMS, and claims).
- Develops process solutions to claims adjudication and eligibility in response to inquiries from other areas.
- Develops and/or reviews quality control results in a timely manner.
Claims Research Analyst (Medicaid)
PGBA
01.2020 - 11.2022
- Verify disbursement requests to ensure the request is valid and appropriately documented. Research rejected, transition, and paid status claims for validity and escalate as appropriate. Use the various systems of the department/company to complete research and gain sufficient knowledge of the claims system and how it relates to other systems.
- May research claims to identify or validate fraud, waste or abuse.
- Monitor inventory reports to ensure claims are resolved accordingly. Provide documentation as requested for audit purposes. May provide written or telephone correspondence to resolve claims issues.
- Research claims as related to billing or crediting groups. Research claims to ensure the proper adjustments are made and groups receive credit or are billed appropriately.
Physician Office Assistant
Palmetto Health USC Medical Group Ophthalmology
Columbia
08.2018 - 08.2019
- Answers phone inquiries regarding medical records and perform other clerical functions within the team as designated by the practice manager.
- For non-electronic medical record (EMR) practices, pulls and files charts for patient appointments, staff, physicians and/or other requests; ensures all charts are organized to protocol.
- For EMR practices, imports lab reports, correspondence, physician dictation/notes, progress notes, radiology reports and other approved documents into the electronic medical record.
- Ensures fulfillment of all mailed-in and faxed requests for medical records from insurance companies, managed care plans, hospitals, attorneys, patients and other physicians-when appropriate releases are provided.
- May complete disability forms and other patient insurance forms within a reasonable timeframe, bills patient or insurance company.
- Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.
- Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
- Completes pre-registration, verifies insurance, and collects payments from check out window. Follows through with past due accounts and accounts in collection.
- Performs other miscellaneous duties including back-up coverage for other office employees and participating in a variety of projects and tasks as needed and directed by management.
Appeals Coordinator (Medicare)
Palmetto GBA
01.2018 - 08.2018
- Responsible for maintaining the proper flow of the request for appeals.
- Performs non-medical reviews and processes redetermination letters.
Optometric Assistant
Focus Eye Care
Columbia
06.2008 - 01.2010
- Patient preparation- Taking patients history, IOP, Auto refractor, Patient Acuities, Dilation, Visual fields, Oculus, Glaucoma detection machine (GDX).
- Insurance Verification / Collect co-payments.
- Checking Patients in & out and Taking payments.
- Scheduling and confirming appointments.
- Billing, Data Entry and Filing Patients Records.
- Ordered Contact Lens/ Medicaid Glasses and Call in Patients Rx/ Referrals to Specialists.
Optometric Assistant
Lens Crafters- Dr. Mark Robertson’s Office
Florence
04.2007 - 06.2008
- Patient preparation- Taking patients history, IOP, Auto refractor, Visual fields, Patient Acuities and Dilation.
- Insurance Verification / Collect co-payments.
- Checking Patients in & out, Filing Patients Records.
- Taking payments.
- Scheduling and confirming appointments.
- Ordered contact lens and Call in Patients Rx/ Referrals.
Education
Database Analyst - Information Technology
Midlands Technical College
Columbia, SC05.2025
Pre Health Care Certificate - Pre-Health Care
Midlands Technical College
Columbia, SC05.2018
EKG Technician -
Absolute Medical Training
Florence, SC05.2011
High School -
Timmonsville High School
Timmonsville, SC05.2003
Skills
- Microsoft Office
- Database management
- Data analysis
- Research skills
- Communication skills
- Attention to detail
- Team collaboration
- Problem solving
- Medical Terminology
- SQL
- Database Design
- Crystal Reports
- Business Intelligence
- Agile Fundamentals
- Data management
- Office administration
- Scheduling proficiency
Certification
DOD Security Clearance Tier 1, 07/11/23, Present
Volunteer Experience
Florence Boys & Girls Club
Timeline
Program Coordinator II
SCDHHS
09.2023 - Current
Operations Analyst (Medicare)
PGBA
11.2022 - Current
Claims Research Analyst (Medicaid)
PGBA
01.2020 - 11.2022
Physician Office Assistant
Palmetto Health USC Medical Group Ophthalmology
08.2018 - 08.2019
Appeals Coordinator (Medicare)
Palmetto GBA
01.2018 - 08.2018
Benefit Files
Blue Cross & Blue Shield
02.2013 - 08.2024
Optometric Assistant
Focus Eye Care
06.2008 - 01.2010
Optometric Assistant
Lens Crafters- Dr. Mark Robertson’s Office
04.2007 - 06.2008
Database Analyst - Information Technology
Midlands Technical College
Pre Health Care Certificate - Pre-Health Care
Midlands Technical College
EKG Technician -
Absolute Medical Training
High School -
Timmonsville High School
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