Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Jennifer Johnston

Business Office Director
Bothell,Washington

Summary

In my 25 years in the Healthcare field, I have gained experience in the following: Supervisor/Director duties, training new hires, reporting, analytics, assisting in resolving customer complaints, medical records abstraction, Medicare/Medicaid & commercial insurance billing, verification, authorizations, & appeals. I have worked with software such as EPIC, Meditech, A/S400 (MS4), Tandem, & QNXT. I am also a Certified Notary Public in Washington State. Hardworking Patient Account Representative dedicated to customer service and patient care. Outgoing and flexible team player. Talent for developing creative solutions that satisfy all parties. Motivated Patient Account Representative offering [Number] years of healthcare and customer service experience. Highly effective time management, conflict resolution and communication skills. Skilled professional with experience in collections, customer service and data entry. Exceptional interpersonal and problem-solving skills. Effectively mediates customer disputes and collects payment in timely manner. Competent Accounts Receivable Specialist bringing [Number] years of experience handling accounts receivable functions. Exemplary skill in resolving billing disputes, providing excellent customer service and applying payments. Recognized for effective leadership with consistent achievement of objectives.

Overview

28
28
years of professional experience
1
1
Certification

Work History

Business Office Director/Manager/Lead Patient Account Rep, Medicare

UHS, Inc, Fairfax Hospital
07.2019 - Current
  • Biller Complete weekly A/R Minutes & review with CFO/CEO, UR, & Regional Directors
  • Attend meetings with Insurance Representatives for updates &/or issue escalation
  • Run & distribute daily/weekly reports for staff – Unbilled, Payment/Adjustment, etc
  • Train new employees
  • Manage any special projects and analytics for Business Office as needed
  • Assist in maintenance of denial log to include working high priority denial/appeals
  • Bill all BHASO claims for Involuntary admissions (ITA)
  • Bill all Medicare/Managed Medicare claims
  • Assist with billing commercial & Medicaid claims as needed
  • Follow up on aging accounts and appeal submissions
  • Primary resource for Business Office (Financial Counselor, Billing, Cash Posting)
  • Back-up Poster for facility revenue
  • Maintain weekly/monthly reporting
  • Maintain denial logs
  • Payroll
  • Coaching/Disciplinary actions
  • Maintain employee files
  • Work with vendors
  • Complete duties as Patient Account Rep/Biller and Financial Counseling

Business Office Assistant/Billing Specialist

Healthcare at Bellevue
11.2017 - 07.2019
  • Bill commercial & Managed Medicare insurance
  • Run and send out private pay statements
  • Follow up on aging accounts
  • Assist patients and family members with billing questions
  • Post insurance payments
  • Maintain facility resident files
  • Verify insurance eligibility
  • Maintain employee files
  • Miscellaneous HR duties (i.e
  • Employment verification, assist employees as needed)
  • Back up assistance for payroll
  • Assist in PBJ submissions to CMS
  • Run E-Verify and DSHS background checks for new/current employees as needed

Sales Associate

Fred Meyer Jewelers
11.2016 - 11.2017

Supervisor

Neighborcare Health
06.2016 - 09.2016
  • Billing and Coding
  • Supervise team of 10
  • Assist in daily coding and billing
  • Assign/distribute and assist with work load when team members are out
  • Distribute daily report of unbilled numbers
  • Manage team time cards
  • Manage requests for time off
  • Professionally & discreetly discuss issues with team members as needed, including verbal and written warnings
  • Distribute employee’s weekly reports such as: productivity, encounters on hold, billable/unbilled, high dollar, aging, etc
  • Take escalated patient calls as needed for resolution

Molina Healthcare of WA
03.2012 - 05.2016

Risk Adjustment Specialist

03.2012 - 04.2014
  • Designed, implemented and successfully managed State Plan Medicare Risk Adjustment Program for 7,500 members from, Currently assist in managing Medicare Risk Adjustment Program for State Health Plan
  • Distribute Molina Risk Adjustment forms to providers
  • State Health Plan Liaison with Corporate Risk Adjustment Management
  • Contact and meet with providers for engagement in Risk Adjustment programs
  • Request, track, and manage medical records received for provider incentive payments
  • Monitor acceptable & unacceptable program forms received for incentive payment
  • Request medical records as needed
  • Run reports as necessary for providers and internal needs

Registry Coordinator

Swedish Medical Center
03.2010 - 03.2012
  • Quality and Patient Safety
  • Coordinate participation in internal and external data registries
  • Abstract clinical data from EPIC for quality projects: SCIP and SCOAP
  • Enter data into applications
  • Identify and track patients to assure complete capture of data sets
  • Improve data capture methods to achieve greater accuracy and efficiency

Regulatory Specialist

Health Services NorthWest
01.2009 - 03.2010
  • Medicare
  • Submit claims to Medicare via EPIC & Meditech
  • Review Medicare denials
  • Meet goals for A/R days and incoming payments
  • Adjust claims per guidelines
  • Initiate adjustments on accounts per guidelines
  • Submit reconsideration/appeals requests to Medicare
  • Review claims to ensure clean claim is submitted
  • Work claims in Return to Provider (RTP)
  • Track CMS Probe Audit amounts & report to Billing Director & Senior Director of Operations
  • Follow up on all claims for Audit from initial medical records request to appeals
  • Above average accounts worked per day
  • Resource for Lead in researching billing regulations
  • Assist teammates as necessary to assist in meeting departmental goals

Care Specialist

Molina Healthcare of Washington, MMOP
10.2007 - 01.2009
  • Special Programs-WMIP/, Receive and load authorization requests received via fax or phone
  • Determine if procedures requested meet interqual
  • Make quarterly calls to members to check health status/needs
  • Assist members in resolving billing issues as necessary
  • Assist members in finding participating providers
  • Notify providers of approvals/denials via phone or fax
  • Assist in finding appropriate CPT, HCPC and ICD-9 as necessary
  • Work with the Clinical Staff & Medical Director in case managing member’s care
  • Team resource for authorizations and interqual

Utilization Management Coordinator

Molina Healthcare of Washington
10.2007 - 01.2009
  • I-Healthy Options/Basic Health
  • Receive and load authorizations received from providers into system
  • Verify CPT for authorization request
  • Obtain necessary clinical notes to process authorization request
  • Route authorization request to appropriate persons
  • Notify providers of approvals/denials via phone or fax
  • Adhere to the turn-around times for authorization completion

Compliance Auditor

Accountemps/Protiviti, Robert Half, Inc, Overlake Outpatient Rehab
09.2007 - 10.2007
  • Review pre-selected charts
  • Compare documentation in charts with CPT coding billed
  • Identify and document inconsistencies in charting and coding
  • Document results of audit in spreadsheet
  • Present findings with Department Manager and Audit Manager
  • Provide suggestions for improvement in charting/coding compliance

Eligibility Counselor

Intermountain Healthcare, IHC, IHC-LDS Hospital
04.1996 - 08.2007
  • Excellent at screening patients for funding
  • Assist patients in completing applications for Medicaid, Crime
  • Victims and other funding sources
  • Follow up on application status for programs
  • Work daily reports: unbilled, aging
  • Assist walk-ins (customers without an appointment)
  • Work with Case Managers regarding medical coverage & funding for treatment
  • Visit inpatient customers in rooms
  • Financial Assistance pre-approvals
  • Collect deposits from patients
  • Authorize posting of medications to accounts per guidelines
  • Refer appropriate accounts to outsource vendors (i.e
  • Send accounts to collections)
  • Team resource person
  • Acting Team Lead and Train new hires
  • Provide cost estimates for procedures based on CPT
  • Work with Supervisor to identify areas for improvement & resolution
  • Create “cheat sheets” & training modules for eligibility screening
  • Patient Service Rep III-Medicare, IHC- Urban Central Region Billing
  • Work daily reports: credit, unbilled, payment/adjustment, aging
  • Handle accounts for LDS, Cottonwood, Alta View & The Orthopedic Specialty Hospitals
  • Work in RTP (Medicare) correcting claim errors from the billing team
  • Bill insurances, Medicare primary and all secondary insurances
  • Make payment arrangements with patients
  • Assist with customer and insurance billing inquiries
  • Verify insurance payments are correct
  • Ensure patient receives the correct statements
  • Send accounts to collections
  • Excellent MSP billing resource
  • Health Unit Coordinator, IHC-Primary Children’s Medical Center
  • Verify and enter doctor’s orders
  • Receive results from lab and radiology technicians
  • Notify departments and nurses of orders
  • Answer multiple phone lines
  • Register patients
  • Team resource person
  • Collect deposits from patients
  • Determine appropriate ER charges based on chart notes
  • Assist in educating clinical staff on charting to ensure accurate charges on account
  • Enter charges in patients’ accounts
  • Assist in training new hires

Financial Counselor

Intermountain Healthcare, IHC, con, t, IHC-Primary, s Medical Center
04.1996 - 08.2007
  • Work daily reports: credit, unbilled, payment/adjustment, aging
  • Bill commercial insurances
  • Make payment arrangements with patients
  • Assist with customer and insurance billing inquiries
  • Verify insurance payments are correct
  • Ensure patient receives the correct statements
  • Send accounts to collections
  • Process charity applications and request approval/denial
  • Main Cashier, IHC-Primary Children’s Medical Center
  • Accept payments from patients
  • Accept deposits from hospital departments
  • Maintain drawer balance
  • Maintain Daily Balancing Summary

Education

AAPC CPC online course completed – not certified -

Skills

  • Supervisory experience
  • Project Management experience
  • Proficient in
  • Office (Excel, Word, etc)
  • Experience in Facility & Professional claims
  • Medicare & Medicaid eligibility knowledge
  • Medicare system (DDE/FISS)
  • Training experience
  • Knowledge of CPT, HCPC, ICD-10, & HCC coding
  • Excellent interpersonal skills
  • Detail oriented
  • Excellent multi-tasking
  • Excellent communication skills
  • Quick & eager learner
  • Medicare Risk Adjustment experience
  • Operational Requirements
  • Medical Billing
  • Account Resolutions
  • Accounts Payable and Accounts Receivable
  • Electronic and Paper Filing

Certification

AAPC CRC online course completed – not certified Certification Washington State Notary Public

Timeline

Business Office Director/Manager/Lead Patient Account Rep, Medicare

UHS, Inc, Fairfax Hospital
07.2019 - Current

Business Office Assistant/Billing Specialist

Healthcare at Bellevue
11.2017 - 07.2019

Sales Associate

Fred Meyer Jewelers
11.2016 - 11.2017

Supervisor

Neighborcare Health
06.2016 - 09.2016

Molina Healthcare of WA
03.2012 - 05.2016

Risk Adjustment Specialist

03.2012 - 04.2014

Registry Coordinator

Swedish Medical Center
03.2010 - 03.2012

Regulatory Specialist

Health Services NorthWest
01.2009 - 03.2010

Care Specialist

Molina Healthcare of Washington, MMOP
10.2007 - 01.2009

Utilization Management Coordinator

Molina Healthcare of Washington
10.2007 - 01.2009

Compliance Auditor

Accountemps/Protiviti, Robert Half, Inc, Overlake Outpatient Rehab
09.2007 - 10.2007

Eligibility Counselor

Intermountain Healthcare, IHC, IHC-LDS Hospital
04.1996 - 08.2007

Financial Counselor

Intermountain Healthcare, IHC, con, t, IHC-Primary, s Medical Center
04.1996 - 08.2007

AAPC CPC online course completed – not certified -

Jennifer JohnstonBusiness Office Director