EFFUA JOHNSON
Washington,DC
Summary
With over 20 years of professional business experience, equipped to contribute acquired customer service, communication, analytical, and organizational skills to the field of customer support. Self-motivated individual excelling in problem-solving and possessing strong analytical abilities. Sets effective priorities and implements decisions to achieve both immediate and long-term goals. Dedication to exceptional customer service is unwavering, priding on being detail-oriented, accurate, and well-organized. Proficient in various software applications such as Microsoft Windows XP and NT, Microsoft Office (Word, Excel, and PowerPoint), Lotus Suite, and MS Works, well-equipped to handle any task efficiently.
Overview
28
28
years of professional experience
Work History
Concierge
P&T Managemenet
09.2019 - Current
- Maintained front desk's concierge book to provide visitors with access to relevant local information.
- Remedied issues quickly and effectively through active listening, conflict resolution, and dynamic communication skills.
- Greeted guests upon arrival and offered directions to key amenities to cultivate quality hotel experiences.
- Addressed customer inquiries with timely and professional responses via phone, email and in-person interactions.
Senior Advisor, Customer Service - Correspondence Appeals
CareFirst Blue Cross Blue Shield
01.2008 - 03.2019
- Investigate inquiries from Contracting Providers and Members to include health care professionals, facilities, brokers, and vendors received orally and in writing
- Respond to customer inquiries via telephone, email and correspondence
- Serve as an intermediary between all participating provider, members and other sectors of the company
- Knowledge of Third Party Liability procedures and regulations concerning the coordination of benefits with other health insurance coverage private/public
- Research system errors related to claims processing and recommend corrections
- Review claims processing regarding matters such as: subrogation, fraud, workers compensation, other party liability, Medicare, electronic billing, and fee schedules
- Review usage and application of ICD-9, ICD-10 CM, CPT-4, HCPCS, and DRG
- Demonstrate knowledge of HMO, PPO, Indemnity, Prescription and Dental products
- Research and investigate, discrepancy relating to claims, benefits, referrals and authorizations
- Experience with Electronic Medical Records
Customer Service Representative I
CareFirst BlueCross Blue Shield
01.2006 - 01.2008
- Responsible for receiving a high volume of incoming inquiries via telephone from physicians' offices and hospitals, assist providers with our members' medical/dental benefits and eligibility
- Verify payment status
- Record detail inquiries that need further action and work closely with other departments to resolve problems and provide information
- Research independently utilizing multiple resources such as training, policy manuals, Intranet, standard operating procedures and memos
- Utilize written communication skills and proper telephone techniques effectively
- Knowledge to accurately process explanation of benefits or knowledge in interpreting an employer's explanation of health insurance benefit
Customer Service Department Supervisor
Hospital for Sick Children
01.1998 - 01.2006
- Supervised and monitored a department of nine staff members
- Ensured the smooth and effective operation of the Customer Service Department
- Analyzed, recorded and reported all compliance and customer service issues to department heads
- Responsible for creating and maintaining Access databases
- Accountable for ordering supplies, maintaining inventory and submitting invoices to accounts payable
- Updated and improved work flow processes by tracking and trending the productivity of the Customer Service Department
- Fostered communication with all vendors and members within the HSC Foundation
- Resolved/Researched all customer service issues in an accurate and timely manner
- Chief operator of a multi-line communication system
- Updated, filtered and queried organization's patient database
Outreach Associate
Health Services for Children with Special Needs
01.1997 - 01.1998
- Contacted HSC members for appointments and record updates
- Increased community awareness of HSCSN/NET benefits and services
- Responsible for marketing initiatives and soliciting charitable donations for the HSC Foundation
- Served as a liaison between HSC Members and the Customer Service Department and Administrative Staff
Education
Phlebotomy Certification -
Prince George's Community College
01.2004
Medical Assistance Certification - undefined
Prince George's Community College
01.2003
Medical Terminology Certification - undefined
Prince George's Community College
01.2003
Skills
- Front desk support
- Excellent multitasking
- Effective problem solving
- Issue troubleshooting
- Outstanding customer service
- Strong work ethic
- Telephone etiquette
- Administrative support
- Verbal and written communication
Timeline
Concierge
P&T Managemenet
09.2019 - Current
Senior Advisor, Customer Service - Correspondence Appeals
CareFirst Blue Cross Blue Shield
01.2008 - 03.2019
Customer Service Representative I
CareFirst BlueCross Blue Shield
01.2006 - 01.2008
Customer Service Department Supervisor
Hospital for Sick Children
01.1998 - 01.2006
Outreach Associate
Health Services for Children with Special Needs
01.1997 - 01.1998
Medical Assistance Certification - undefined
Prince George's Community College
Medical Terminology Certification - undefined
Prince George's Community College
Phlebotomy Certification -
Prince George's Community College
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