Kim Johnson
Metro Detroit,MI
Summary
Experienced Contract Specialist with 25 years of experience in contract administration and management. Proficient in monitoring contractor's performance with contract requirements and contract funding and expenditures. Detail-oriented in planning and managing procurement programs and contracting activities. Thorough in administering contract processes and ensuring policy and regulatory compliance. Committed to resolving contractor performance issues by devising solutions.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Medicaid Contract Specialist
Optum Care/United Healthcare
01.2018 - Current
- Manage SNF contracts including validation of demographics, credentialing and system accuracy prior to installation in applicable systems
- Coordinate with quality audit team both pre and post implementation to ensure accuracy of contract loading and claim payment accuracy based on contract intent
- Ensured timely fulfillment of contractual requirements by closely monitoring progress and addressing potential issues proactively.
- Reviewed subcontractor agreements to ensure compliance with all relevant regulations, minimizing risk exposure.
Customer Service Quality Analyst
Optum Healthcare/United Healthcare
01.2017 - 01.2018
- Ensure customer needs are being met by current process (e.g., review recorded conversations, identify/communicate opportunities for improvement)
- Reduced customer complaints by 37% through analysis of call center data, identifying trends & recommending improvements.
- Perform Quality audits and analyze results to determine process improvement opportunities
- Review/monitor results of appeals work and escalate as necessary (e.g., rebuttals)
Senior Provider Data Analyst
United Healthcare
01.2013 - 01.2017
- Identify solutions to non-standard requests and problems
- Solve moderately complex problems and/or conducts moderately complex analyses
- Contributed to business growth by identifying opportunities for expanding the provider network based on thorough market analysis.
- Assisted in the negotiation process with external partners by providing essential information about the current state of the organization''s provider network.
End to End Quality Analyst - Business Process Quality Management
United Healthcare
01.2015 - 01.2016
- Review All medical claims working in CSP
- Rear End, End to End claims ensure that claims are corresponding with criteria based on processing
- Identify any Benefit, Configuration, or Transaction issues
- Review and determine problem
- Provide feedback
- Identify all claim issues to make corrections and improve Quality of business process management.
SAM Adjustment Specialist
Optum Insight Health Plan
01.2013 - 01.2015
- Review all claims in SAM testing Environment
- Review claims edits
- Ensure that claim is corresponding with criteria for edit rule
- Identify payment issues related to edit rule
- Identify configuration issues
- Review and make necessary adjustments
- Provide immediate support to SAM Edit Rule Writers
- Provide feedback to SAM Edit Rule writers/ management
- Compile cost related errors in ARO reports
- Identify payment issues/ claim issue to reduce error and improve business process.
FACETS Transaction Auditor
Great Lakes Health Plan
01.1999 - 01.2013
- Compile monthly Medicare and Medicaid reports
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Identify Fraud & Abuse
- Identify system errors recommend actions to management
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
Education
Ferris State University
04.2024
Oakland Community College
12.2015
Skills
- Risk Mitigation
- Contracting policies and regulations
- Medical Terminology, ICD-9 Coding
- Microsoft Office (MS Excel,Word, PowerPoint)
- SAM Auditing
- Facets CSP
- Legal Compliance
- Excellent written and communication skills
Accomplishments
- Promoted to a mid-level position from an entry-level job just 4 months following hire date.
- Received the Quality for outstanding job performance.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Documented and resolved Appeals which led to Resolution of complaint.
- Supervised team of 4 staff members.
Certification
- Certified Facets Training - 12 years
Timeline
Medicaid Contract Specialist
Optum Care/United Healthcare
01.2018 - Current
Customer Service Quality Analyst
Optum Healthcare/United Healthcare
01.2017 - 01.2018
End to End Quality Analyst - Business Process Quality Management
United Healthcare
01.2015 - 01.2016
Senior Provider Data Analyst
United Healthcare
01.2013 - 01.2017
SAM Adjustment Specialist
Optum Insight Health Plan
01.2013 - 01.2015
FACETS Transaction Auditor
Great Lakes Health Plan
01.1999 - 01.2013
Ferris State University
Oakland Community College
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