Lori Johnson
Apple Valley ,MN
Overview
4
4
years of professional experience
Work History
Member Experience Advocate
Blue Cross Blue Shield of MN
Eagan, MN
08.2023 - Current
- Addressed member questions related to Medicare coverage, focusing on enrollment procedures, claims processing, eligibility criteria, and billing inquiries.
- Implemented effective de-escalation strategies to address and resolve member issues, ensuring regulatory compliance.
- Executed thorough documentation and timely forwarding of grievance requests to appeals and grievance department, maintaining strict policy compliance.
- Documented member service calls accurately to uphold service standards and meet compliance requirements.
Member Experience Advocate
Blue Cross Blue Shield of MN
Eagan, MN
04.2025 - 05.2026
- Responded to inquiries from enrolled and prospective providers, ensuring clarity and understanding of benefits and claims processes.
- Employed analytical expertise to enhance efficiency in navigating various information systems.
- Implemented processes to ensure HIPAA compliance, prioritizing confidentiality for both providers and members.
- Engaged with internal teams to resolve intricate service inquiries, thereby improving provider satisfaction.
Eligibility Representative
Accredo
Memphis, TN
06.2022 - 08.2023
- Processed eligibility requests efficiently, ensuring compliance with company policies and regulations.
- Reviewed patient documentation to confirm eligibility for various health programs and services.
- Collaborated with healthcare providers to gather necessary information for accurate eligibility determinations.
- Utilized electronic systems to track, manage, and document eligibility cases effectively.
Education
Bachelor of Science - Business Administration And Management
Southwest Minnesota State University
Marshall, MN05-1987
Skills
- Active listening
- Critical thinking
- Claims processing
Timeline
Member Experience Advocate
Blue Cross Blue Shield of MN
04.2025 - 05.2026
Member Experience Advocate
Blue Cross Blue Shield of MN
08.2023 - Current
Eligibility Representative
Accredo
06.2022 - 08.2023
Bachelor of Science - Business Administration And Management
Southwest Minnesota State University