DONIELLE JOHNSON
Las Vegas
Summary
Dedicated patient account representative bringing fourteen years of experience in customer service and healthcare support. Well-developed communication, time management and problem-solving abilities.
Overview
14
14
years of professional experience
Work History
Patient Access Representative
Universal Health Services
10.2021 - 11.2024
- Verified insurance coverage for services provided by the facility.
- Submitted claims to insurance companies electronically or by mail.
- Verified accuracy of patient information and insurance data in billing system.
- Resolved denied claims by researching payer requirements and preparing appeals.
- Maintained up-to-date knowledge of coding regulations and changes in reimbursement policies.
- Analyzed patient accounts for errors, inaccuracies or discrepancies in billing documentation.
- Processed corrections and adjustments as needed to ensure accurate payment from third party payers.
- Developed an understanding of how various insurance plans process claims for reimbursement purposes.
- Maintained current CPT, HCPCS codes library as well as ICD-9, 10 CM diagnostic codes.
- Ensured timely filing of all claims within established guidelines.
- Responded promptly to requests from insurance companies regarding clarification on claim submissions.
- Identified trends in denials and worked collaboratively with clinic staff to reduce denials.
Medical Billing Manager
Urology Office
09.2020 - 09.2021
- Reviewed medical records and identified diagnosis codes, procedures, services and supplies for coding.
- Verified accuracy of patient information and insurance data in billing system.
- Submitted claims to insurance companies electronically or by mail.
- Resolved denied claims by researching payer requirements and preparing appeals.
- Reconciled accounts receivable to ensure accuracy of payments received.
- Performed daily audits on all bills submitted for accuracy and completeness.
- Interpreted physician orders, notes, lab results, radiology reports. for appropriate code assignment.
- Worked closely with physicians to obtain additional clinical information when needed for accurate coding assignments.
- Maintained current CPT, HCPCS codes library as well as ICD-9, 10 CM diagnostic codes.
- Identified trends in denials and worked collaboratively with clinic staff to reduce denials.
- Monitored aging accounts receivable report weekly to identify unpaid balances due.
- Tracked details such as authorizations, pre-certifications or referrals required prior to service delivery.
- Filed and submitted insurance claims.
- Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
Medical Billing and Collections Specialist
Nevada Spine Clinic
10.2018 - 03.2020
- Identified, researched and resolved billing variances to maintain system accuracy and currency
- Managed efficient cash flow reporting, posted insurance EFT, checks, cash payments and patient receipts, analyzed recoupments, independently addressing and resolving issues
- Handled 30+ in-bound calls pertaining to reconciliation of delinquent accounts
- Corrected and Appealed Denied Claims
- Requested ASC and In office Authorization for treatment/surgery
Medical Insurance Biller
Vantage Oncology Inc.
05.2014 - 08.2018
- Posted payments and collections on regular basis
- Maintained current accounts through aged revenue reporting
- Transferred balances to correct payers
- Verified proper ICD-9/ ICD-10 coding on claims
- Delivered timely and accurate charge submissions
- Guarded against fraud and abuse by verifying all coded data accurately reflected services provided
- Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments
- Reviewed outgoing bills for eligibility and accurateness
- Prepared billing statements for patients and verified correct diagnostic coding
Medical Billing Specialist
West Gastroenterology
09.2010 - 03.2014
- Located errors and promptly refiled rejected claims
- Trained new employees on multiple medical billing programs and data entry software
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy
- Posted and adjusted payments from insurance companies
- Evaluated patients' financial status and established appropriate payment plans
- Printed and reviewed monthly patient aging report and solicited overdue payments
- Accurately posted and sent out all medical claims
- Precisely evaluated and verified benefits and eligibility
- Determined prior authorizations for medication and outpatient procedures
- Communicated effectively and extensively with other departments to resolve claims issues
- Accurately posted surgeries, hospital visits and payments for assigned carriers
- Scanned and filed medical records in alphabetical order to maintain organized and up-to-date filing system
- Communicated with insurance providers to resolve any denied claims and resubmit
Education
Medical Billing And Coding Certificate - Medical Billing And Coding
Charter College
Long Beach, CA05-2010
High School Diploma -
Gardena High School
Gardena, CA06.2005
Skills
- Aging reports analysis
- Surgery Coding
- Cash application
- MS Office
- Customer service
- 60 wpm
- Insurance Verification
- Coding
- Follow-up skills
- Verbal and written communication
- Insurance collaboration
- Payment processing
- Medical terminology knowledge
- HIPAA compliance
- Data entry proficiency
- Administrative support
Timeline
Patient Access Representative
Universal Health Services
10.2021 - 11.2024
Medical Billing Manager
Urology Office
09.2020 - 09.2021
Medical Billing and Collections Specialist
Nevada Spine Clinic
10.2018 - 03.2020
Medical Insurance Biller
Vantage Oncology Inc.
05.2014 - 08.2018
Medical Billing Specialist
West Gastroenterology
09.2010 - 03.2014
High School Diploma -
Gardena High School
Medical Billing And Coding Certificate - Medical Billing And Coding
Charter College
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