Johanna Bowen

• Handle incoming calls from members, addressing customer needs, which may include benefit questions, resolving issues, and educating customers.
• Navigated through computer systems to review information and respond appropriately to callers.
• Record details of inquiries, comments, or complaints, transactions, or interactions with each caller.
• Escalate unresolved and pending grievances.
• Monitored customer feedback to identify areas of improvement in terms of meeting members' needs.
• Ensured compliance with applicable laws and regulations relating to contact center operations.
• Adhered to established policies and procedures while providing exceptional customer service.
• Attended training sessions aimed at enhancing knowledge of relevant software applications and systems used in the contact center environment.

Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.

• Assisted teachers with planning and preparing lessons for students.
• Provided guidance to students in the classroom setting.
• Created and maintained positive relationships with students, parents, and colleagues.
• Supervised small groups of students during instruction time.
• Administered assessments to determine student's academic performance levels.
• Assisted in the implementation of educational programs for special needs children.
• Instructed students using a variety of teaching methods such as lectures, discussions, audio-visual presentations.
• Conducted one-on-one tutoring sessions with struggling students when needed.
• Attended professional development workshops related to job responsibilities.
• Ensured that all safety regulations were followed in the classroom environment.
• Handled clerical duties, managed classrooms and coordinated documents for teachers.

• Responded to patient inquiries regarding billing or financial matters.
• Assisted with scheduling outpatient appointments.
• Ensured accuracy of all data entered into computer system.
• Created new patient accounts in EMR system as needed.
• Performed pre-registration functions such as verifying demographic information, obtaining authorizations, and collecting deposits and co-payments.
• Provided assistance to internal departments when needed.
• Answered phones promptly in a professional manner.
• Kept patient appointments on schedule by notifying providers of patients' arrival and reviewing service delivery compared to schedule.
• Addressed patient inquiries and concerns, resolving issues in a timely and empathetic manner.
• Handled high volume of incoming calls, providing exceptional customer service to patients and families.

• Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
• Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
• Processed a high volume of incoming claims in accordance with established policies and procedures.
• Adhered to all applicable laws, regulations, and company standards while processing claims.
• Researched discrepancies between submitted documentation and actual records to identify errors or omissions.
• Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
• Maintained accurate records of all processed claims in accordance with departmental requirements.
• Assisted customers via telephone inquiries related to their specific claim status or general questions about the company's services.
• Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
• Managed workload to meet or exceed productivity and quality standards.

• Reviewed prior authorization requests for completeness and accuracy.
• Assessed insurance benefits and determined eligibility criteria.
• Researched medical policies to ensure appropriate coverage of services.
• Processed appeals for denials in accordance with established procedures.
• Provided timely feedback to physicians regarding authorization status.
• Responded promptly to inquiries from providers, members, and other departments within the organization.
• Advised healthcare professionals on proper coding practices that meet requirements of payers.
• Educated customers about the prior authorization process including applicable deadlines.
• Maintained files for referral and insurance information, entering referrals into system.
• Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
• Maintained high level of professionalism when speaking to doctors and insurance companies.

• Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
• Conducted performance appraisals for team members, providing feedback and identifying areas of improvement.
• Resolved escalated customer complaints or queries promptly and efficiently.
• Ensured compliance with company policies and procedures throughout the team.
• Supported the manager in developing plans for future projects, initiatives and objectives.
• Assisted the manager in setting achievable goals for the team while monitoring progress towards them.
• Delegated tasks appropriately according to individual skill sets.
• Held regular one-on-one coaching sessions with staff members to encourage personal development.