Johnisha Broadnax
Tampa
Summary
Results-driven healthcare professional with 10 years of experience in healthcare, UB-04, and CMS 1500 Medicare, Medicaid, third-party health insurance claims processing, and patient care. Known for optimizing workflows, ensuring claim accuracy, and resolving complex issues. Proven track record of improving customer satisfaction ratings by 95% and managing a caseload of over 140 claims per week. Certified Clinical Medical Assistant skilled in utilizing EMR, EHR systems, and maintaining compliance with industry standards. Open to relocating to Florida and authorized to work in the US for any employer.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Provider Payment Reconsideration
Elevance Health (anthem)
01.2023 - 03.2025
- Reviewed Provider disputes in regards to denied claims for improper coding ,duplicate submission,corrected claim,rejected claim,Retroactive Medicaid ,EOB's,inactive third party payment,incorrect submission mother baby claims including UB04,CMS1500
- Implemented efficient workflows and processes to optimize coding accuracy and efficiency
- Collaborated with various departments
- Investigated and analyzed claim documents, including medical records
- Prepared notification letter of denial upheld or overturned and payment of dispute
- Managed a caseload of 140 + claims simultaneously while meeting quality standards and turnaround time expectations
United Healthcare Representative
Medicare Claims
05.2021 - 01.2023
- Investigated and resolved complex claim issues by analyzing medical records, policy documents, and billing information
- Identified potential fraudulent activities or billing errors through careful analysis of claims data
- Maintained a high level of productivity while meeting quality standards in processing a large volume of claims daily
- Utilized coding systems such as CPT, ICD-10, HCPCS to accurately assign appropriate reimbursement codes for services rendered
- Ensured timely resolution of outstanding claims by following up with payers regularly
- Performed audits on processed claims to identify errors
- Maintained accurate documentation of all actions taken during the claims review process for audit purposes
Customers Service Representative
United Healthcare
01.2018 - 05.2021
- Handled high-pressure scenarios with professionalism.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Communicated with various business departments to verify member information
Education
Associate's degree - Healthcare
University of South Florida
Tampa, FL04.2017
Skills
- Microsoft Word
- Microsoft Excel
- ICD-10
- UB-04 (10 years)
- CPT coding
- Medical coding
- Organizational skills
- Certified coding specialist (1 year)
- EMR systems
- Medical terminology
- Medicare
- Medical records
- Medical billing
- Anatomy knowledge
- Friendly, positive attitude
- Teamwork and collaboration
- Problem-solving
Certification
Certified Medical Assistant
Accomplishments
98% Quality metrics 12 months Claims
99% Quality Provider Dispute correct Resolutions Overturns
99% Quality Customer service
Timeline
Provider Payment Reconsideration
Elevance Health (anthem)
01.2023 - 03.2025
United Healthcare Representative
Medicare Claims
05.2021 - 01.2023
Customers Service Representative
United Healthcare
01.2018 - 05.2021
Associate's degree - Healthcare
University of South Florida
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