Krista Johns
New Windsor,NY
Summary
Experienced Customer Service Representative brings 11+ years of applying exceptional customer service whether Medical or Office setting, conflict mediation and communication skills to address diverse needs. Smoothly mitigate customer conflicts through calm, level-headed strategies. Responsive and resilient team player with adaptable and resourceful mindset.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claims Processor
United Healthcare, UHG
, Remote
11.2022 - Current
- Verified claim data correctness in preparation for processing.
- Reviewed history records to determine benefit eligibility for services.
- Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Precisely calculated refunds, premiums and adjustments.
Express Claims Agent
AllState
Remote
07.2022 - 11.2022
- Worked productively in fast-moving work environment to process large volumes of claims.
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Followed up with customers on unresolved issues.
- Proposed settlements for uncomplicated issues to resolve claims.
- Oversaw claim recoveries, subrogation and salvage.
- Checked level and type of coverage and evaluated contracts.
- Interviewed policyholders to verify information and obtain additional details.
- Generated, posted and attached information to claim files.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Processed and recorded new policies and claims.
- Posted payments to accounts and maintained records.
Customer Care Agent
LimeLife By Alcone
Remote
08.2020 - 07.2022
- Provided customer care by answering phone calls and emails to assist customers using zendesk and exigo programs
- Processed new orders, processed refunds and also Troubleshooting customer accounts
- Billing issues and fraud management
- Maintained the call que by being efficient, handling a large volume, 40-50 calls per day and answering customer questions and escalating inquiries to the correct department.
Patient Care Assistant
Montefiore St. Luke’s Cornwall Hospital
Newburgh, NY
07.2019 - 01.2022
- Maintained accurate records of patient care, condition, progress and concerns
- Responded appropriately to the physical, emotional and developmental needs of patients
- Collect vital signs and finger sticks and document
- Assisted patients with bathing, oral hygiene, grooming, feeding and elimination
- Maintained a clean, healthy and safe environment
- Assisted with patient transfer and ambulation
- Provide one on one care when needed
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
Direct Support Professional
Abilities First
Poughkeepsie, NY
01.2019 - 04.2021
- Performed direct patient care aimed at increasing comfort, psycho, social and spiritual well-being by providing assistance with personal hygiene, physical comfort, nutrition, elimination, prevention of skin breakdown, rehabilitation and safety
- Monitored progress and documented patient health status changes to keep the care team updated
- Administered medication as directed by the physician
- Maintained a clean, safe and well-organized patient environment
- Cooked meals and assisted patients with eating tasks to support healthy nutrition
- Transported clients to and from medical appointments with safety and efficiency.
Medical Assistant
Digestive Disease Center
Fishkill, NY
11.2016 - 04.2018
- Coordinated patient scheduling, check-in, check-out and payments for billing
- Insurance Claims
- ICD-10 and CPT codes
- Checked patient insurance, demographic and health history to keep information current
- Maintained current and accurate medical records for patients
- Enhanced office productivity by handling high volume of callers per day
- Vital signs, such as blood pressure and Weight
- Schedule office visit appointments and Surgical Scheduling for procedures
- Perform clerical duties, such as word processing, data entry, and filing
- Accession biopsy in the lab and entering grossing information, transcription and documentation
- Monitored expiration of medical supplies and medications
- Obtaining prior Authorization for surgical procedures and medications
- EMR, Microsoft word and Excel experience.
Education
High School Diploma -
Newburgh Free Academy
Newburgh, NY06.2009
Skills
- Claims processing
- Data Entry
- Medical terminology knowledge
- Eligibility
- Documentation and reporting
- Customer Service
- Microsoft Word, Excel, Powerpoint, Access
- ICD-10 and CPT Codes
- Billing coordination
- Dementia and Alzheimer's knowledge Tube feedings and medications familiarity
- EMR / EHR
- Direct Patient Care
- Medical Records Management
Certification
CNA - Certified Nurse Assistant
CPCT/A - Patient Care Technician/Assistant
Timeline
Claims Processor
United Healthcare, UHG
11.2022 - Current
Express Claims Agent
AllState
07.2022 - 11.2022
Customer Care Agent
LimeLife By Alcone
08.2020 - 07.2022
Patient Care Assistant
Montefiore St. Luke’s Cornwall Hospital
07.2019 - 01.2022
Direct Support Professional
Abilities First
01.2019 - 04.2021
Medical Assistant
Digestive Disease Center
11.2016 - 04.2018
High School Diploma -
Newburgh Free Academy
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