JaNiya Woods
Phenix City
Summary
Accomplished Medical Claims Analyst with expertise in healthcare regulations and medical compliance at the Department of Veterans Affairs. Proven ability to resolve claim discrepancies and enhance customer service. Demonstrated adaptability and problem-solving skills, training over 11 employees in previous roles, ensuring efficient operations and compliance with industry standards.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Medical Claims Analyst
Department of Veterans Affairs
Tuskegee
10.2024 - Current
- Reviewed medical claims for accuracy and compliance with regulations.
- Collaborated with healthcare providers to resolve claim discrepancies.
- Provided customer service support by responding to inquiries from members, providers, employers, and insurance carriers.
- Maintained current knowledge on Medicare and Medicaid guidelines as well as private insurance plans.
- Enforced compliance with HIPAA privacy laws when dealing with sensitive information.
- Prepared reports summarizing the progress of claims submitted to insurance companies.
- Investigated appeals from providers regarding denied or underpaid claims.
Shift Lead / Pharmacy Technician
Walgreens
Montgomery
05.2022 - 09.2024
- Fill prescriptions by retrieving, counting, and pouring pharmaceutical drugs, and assist pharmacist in scheduling and maintaining workflow; model and deliver exceptional customer service
- Perform duties and utilize pharmacy systems to accurately enter and obtain patient and drug information
- Maintain team members, report cash reports, and stock inventory.
- Supervised daily operations and ensured adherence to company policies.
- Trained and mentored new team members on store procedures.
Customer Service Representative
Walmart
Columbus
01.2020 - 05.2022
- Handled 100+ customer interactions per day, gave friendly and polite service to ensure customer retention and overall satisfaction
- Analyzed all claims exposures, and determined efficient de-escalation techniques according to required policies and procedures
- Memorized all company products and services to efficiently answer customers' questions and concerns
Cashier
Hardees
Phenix City
08.2018 - 01.2020
- Remained courteous, calm, and attentive; especially during times of conflict, and high volume of customer interactions
- Trained and mentored 11 new employees on important company policies and conflict resolution
Education
Alabama High School Diploma -
Central High School
Phenix City, AL05.2020
Skills
- Medical compliance
- Customer service
- Data analysis
- Healthcare regulations
- Problem solving
- Time management
- Inventory management
- Adaptability to change
- Medical coding expertise
- Medical terminology
- Training and mentoring
Certification
Licensed Pharmacy Technician (Alabama) 08/2022
Microsoft Office Specialist
Office PowerPoint 2024
Office Word 2024
Timeline
Medical Claims Analyst
Department of Veterans Affairs
10.2024 - Current
Shift Lead / Pharmacy Technician
Walgreens
05.2022 - 09.2024
Customer Service Representative
Walmart
01.2020 - 05.2022
Cashier
Hardees
08.2018 - 01.2020
Alabama High School Diploma -
Central High School