Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Johnisha Broadnax

Tampa,FL

Summary

1. I have Hands on Experience in the Medical field starting 8years as A Certified Medical Assistant 2. Transitioned into Insurance and Customer Service 3. Currently working Hospital Claims Authorized to work in the US for any employer Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Claims Representative

UHC United Healthcare
08.2022 - Current
  • My Duties include reviewing, researching and processing Hospital claims including auto accident and workers compensation incidents with the goal to ensure that every claim has a fair and thorough review
  • Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g
  • Pricing, prior authorizations, applicable benefits)
  • Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g
  • Claims processing policies and procedures, grievance procedures, state mandates, CMS/
  • Medicare guidelines, benefit plan
  • Review claims for proper coding and format - Also Submitting electronic & paper claims
  • Identifying & troubleshooting claim denials/rejections
  • Reviewing AR Reports to resolve unpaid claims.

CSR - Customer Service

RepresentativeI, UnitedHealth Group
10.2020 - 08.2022
  • Maintain an ongoing responsibility for assigned claims inquiries which entails assessment, education and coordination for members / health care providers throughout the United States via telephone while keeping a detailed record within the internal database
  • Establish and maintain positive relationships with members, providers and our claims contractors
  • Manage inbound and outbound calls from providers and members to resolve claims issues
  • Request and manage medical records to help determine potential program coverage and communicate results to the members
  • Completion of system generated tasks, including documenting all results as required
  • Prepare comprehensive reviews and summaries for claims appeals
  • Point of contact for internal departments to answer questions relative to member claims
  • Work with the leadership team to resolve issues as needed
  • Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcomes
  • Ability to communicate complex program criteria into easily understood summaries in both oral and written communication
  • Validation of claim coverage in relation to program guidelines
  • Compete activities and reporting as required by the fraud, waste and abuse plan

Certified Medical Assistant

Genesis Women's Center
12.2018 - 10.2020
  • Provided prenatal care to expectant mothers and postnatal care to mothers and infants
  • Received Board Certification in Obstetric And Gynecology practice.Provided clinical care encompassing both acute and chronic medical conditions and injuries, admissions, discharge summaries, and managing the hypertension clinic.Performed histories and physical examinations.Treated cases from acute injuries to the common cold.Provided care and counseling to HIV-positive patients, monitoring health conditions and instructions on precautions
  • Worked in a rural health family practice providing health care services
  • Sanitized, restocked, and organized exam rooms and medical equipment.
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.
  • Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
  • Conducted preliminary patient evaluations measuring weight, temperature and blood pressure.
  • Promoted office efficiency, coordinating charts, completing insurance forms, and helping patients with diverse needs.
  • Directed patients to examining rooms and coordinated transportation assistance as necessary.
  • Prepared and administered medications to alleviate patient symptoms.
  • Obtained client medical history, medication information, symptoms, and allergies.
  • Performed medical records management, including filing, organizing and scanning documents.
  • Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
  • Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
  • Completed clinical procedures and gathered patient data for interpretation by physician.

Certified Medical Assistant

Moffitt Cancer Center
12.2015 - 12.2018
  • Assists patients with ambulation and/or movement on/off exam table, chairs and/or in and out of wheelchairs utilizing proper body mechanics and safety measures such as, lift equipment
  • After proper patient identification, performs initial patient screening, including vital signs, screening questions, allergy information, and medication history as appropriate
  • Notifies appropriate staff of positive screening or abnormal vital signs
  • Documents collected data completely and accurately in medical record including staff notifications
  • Loads images in preparation for provider visit, as needed
  • Ensures clinic patient flow is smooth and efficient
  • Keeps patients and clinical team informed of delays
  • Communicates effectively to patients, providers, nurses, and other team members
  • Assists practitioner in patient procedures/treatments/examinations, including room preparation, patient positioning, supplies, and equipment
  • Departs from clinic those patients that do not require nursing intervention
  • Maintains and uses principles of aseptic techniques and universal precautions when performing clinical duties and tasks
  • Maintains the knowledge and skill necessary to provide care or services based on physical, psychosocial, educational, safety, and related criteria appropriate to the age of the patients served in the assigned service area
  • Utilizes computerized systems according to departmental needs
  • Provides support to the provider during clinic by assisting with phone calls and faxes
  • Recognizes emergency situations and implements emergency procedures
  • Administers first aid and
  • CPR
  • Sanitized, restocked, and organized exam rooms and medical equipment.
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
  • Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.

Education

Associate - Science

Hillsborough Community College
Tampa, FL

Skills

  • Venipuncture
  • Aseptic technique
  • Medical Office Experience
  • Infant care
  • Data collection
  • Patient Care
  • Anatomy Knowledge
  • Leadership
  • Patient monitoring
  • Medical records
  • Performed initial assessments, charting, and ordering of lab work and/or x-rays as necessary
  • Monitored and delivered requests for urgent transcription projects to meet needs of physician and
  • Surgery schedules Assessed data on client HMO's outpatient prescription drug use during bi-annual
  • On-site visits, presenting recommendations to promote a quality, cost-effective drug management
  • Program to plan administrators Monitored conscious sedation of all radiology performed procedures
  • To ensure patient comfort Assisted in the creation, revision, and implementation of operating
  • Instructions, policies, and job descriptions to maintain consistent quality
  • Merchandising
  • Medical Scheduling
  • Experience Administering Injections
  • Sales
  • Outbound calling
  • Clerical Experience
  • Laboratory experience
  • Medicare
  • Physical examinations
  • Pricing
  • Teaching
  • Excel
  • CPR
  • Epic
  • Cashiering
  • Research
  • Vital signs
  • Medical imaging
  • Insurance verification
  • Hospital experience
  • Microsoft Office
  • Nursing
  • EMR Systems
  • HIPAA
  • Discharge planning
  • Physiology Knowledge
  • Customer service
  • Office Management
  • Quality Assurance
  • Cold calling
  • Triage
  • First aid
  • Billing Codes
  • Prior Authorization Processing
  • Premium Calculations
  • Data Quality
  • Team Meetings
  • Great Mathematical Skills
  • Insurance Terminology
  • Data Communications
  • Insurance Industry Experience
  • Accident Review
  • Accident Investigations
  • Claims Preparation
  • Recordkeeping Organization
  • Professional Development
  • Data Entry Software
  • Insurance Plan Verification
  • Policy Knowledge
  • Insurance Calculation
  • Exceptional Recordkeeping Abilities
  • Secure Data Practices
  • Electronic Authorization Processing
  • Personal Data Evaluation
  • 10-Key Touch
  • Strategic Initiatives
  • Composing Business Correspondence

Certification

First Aid Certification Certified Medical Assistant CCMA Certification CPR Certification

Timeline

Claims Representative

UHC United Healthcare
08.2022 - Current

CSR - Customer Service

RepresentativeI, UnitedHealth Group
10.2020 - 08.2022

Certified Medical Assistant

Genesis Women's Center
12.2018 - 10.2020

Certified Medical Assistant

Moffitt Cancer Center
12.2015 - 12.2018

Associate - Science

Hillsborough Community College

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Johnisha Broadnax