ALTHEA JOHNSON-GOGO
Worcester,MA
Summary
Experienced in scheduling, multi-tasking, working in a fast paced environment, delivering high quality of work. Demonstrated strengths in office organization, patient centered services, professionalism and confidentiality.
Overview
17
17
years of professional experience
Work History
Grievance and Appeal Specialist
Emblem Health-New York New York (remote)
01.2021 - 01.2024
- Ensure verbal and written responses are provided to members and/or other providers.
- Responded promptly to inquiries from clients or external parties regarding appeal status or process updates.
- Performed quality assurance checks on completed appeal files prior to submission.
- Resolved escalated customer service issues pertaining to denied claims or unresolved appeals cases.
- Reviewed appeal requests to ensure accuracy of information submitted.
- Conducted research on medical records, financial data, and other relevant documents to support appeals.
- Collaborated with other departments within the organization to resolve issues related to appeals.
- Ensured compliance with all applicable laws, regulations, and standards governing appeals processing.
Patient Registration Representative
UMASS MEDICAL HOSPITAL
Worcester, MA
01.2014 - 01.2024
- Greeted patients and answered questions regarding registration process.
- Collected patient demographic information, verified insurance coverage, and updated records as necessary.
- Processed payments for services rendered in a timely manner.
- Updated patient information in database regularly to ensure accuracy of records.
- Responded to inquiries from patients, families, physicians, and other healthcare personnel.
- Performed quality assurance checks on all registrations to ensure accuracy of data entry.
- Provided support to the clinical staff with registration issues or concerns.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Verified insurance eligibility through online portals or by phone calls.
Patient Care Assistant (Endoscopy Department)
UMASS MEDICAL HOSPITAL
01.2007 - 01.2010
- Vital signs, patients appointments scheduling, preparation of patients for medical interventions(surgeries)
- Assisted patients with ambulation and with their discharge process.
- Assisted with daily activities such as bathing, grooming, dressing, feeding, and transferring patients.
- Maintained accurate records of patient care services provided.
- Assisted with ambulation and positioning of patients according to their plan of care.
- Ensured proper nutrition by providing meals, snacks and fluids to patients as instructed by medical staff.
- Helped maintain a clean environment in all areas assigned.
- Responded quickly to emergency situations following established protocols.
Education
High School diploma -
Cornerstone Christian Correspondence School
Townsend, GA06.2021
High School Diploma -
Christiana Secondary High School
Manchester, Jamaica06.1987
Skills
- Insurance verification
- Epic
- Microsoft Office
- Experience with work in a healthcare setting
- EMR systems
- Grievance and Appeals
- Patient Care
- Medical Office
References
References available upon request.
Timeline
Grievance and Appeal Specialist
Emblem Health-New York New York (remote)
01.2021 - 01.2024
Patient Registration Representative
UMASS MEDICAL HOSPITAL
01.2014 - 01.2024
Patient Care Assistant (Endoscopy Department)
UMASS MEDICAL HOSPITAL
01.2007 - 01.2010
High School diploma -
Cornerstone Christian Correspondence School
High School Diploma -
Christiana Secondary High School
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