Melissa Johnson
Victorville,CA
Summary
A Senior Pre-Services Representative with extensive experience in leadership skills and hipaa compliance along with a proven ability to manage cross-functional teams. Given my outgoing, friendly, and people-oriented personality, I connect well with diverse groups and individuals. I am also very well-organized and possess solid communication skills that aid my ability to efficiently support upper management.
Overview
11
11
years of professional experience
Work History
Financial Clearance Specialist III
Keck Medical Center of USC
08.2024 - Current
- Verify patient's medical eligibility, while forwarding eligibility and accumulations to Preregistration department.
- Review Physician's order to determine proper CPT code and ICD-10 prior to submitting for authorization.
- Submit for authorization for upcoming scheduled services.
- Utilize payor portals such as Availity, Carelon, Evolent, and Evicore.
- Follow up on denied authorizations, while forwarding a peer to peer request to ordering Physician regarding further reconsideration.
Senior Pre-Services Representative
Providence St Joseph Health/R1 RCM
12.2023 - Current
- Pre-register patients by telephone for upcoming outpatient services
- Review and interpret patient insurance benefits and financial obligation due at the point of service
- Monitor incoming patient orders and gather information needed to complete the pre-authorization and scheduling of an order
- Follow up with Physician office regarding CPT discrepancies, or to obtain authorization status
- Follow up with commercial insurance providers regarding CPT discrepancies or to obtain authorization status
- Experience with Manage Care Contracts and payor operations
Lead Patient Access Representative
Providence St Mary Medical Center
08.2022 - 12.2023
- Greet incoming patients, visitors and vendors and redirect them to proper area
- Collect patient information, and insurance information for registration process
- Analyze the patient’s insurance eligibility to confirm coverage, medical group and other specific needs pertaining to the date of service
- Follow up with assigned Medical Groups/Ipa regarding admission requests based on the patient’s needs
- Provide coverage for vendors and redirected them to proper area
- Monitor ED workflow and assist with registration discrepancies
- Audit registered charts and provide feedback regarding error rate and productivity
Patient Access Representative
Pomona Valley Hospital Medical Center
05.2019 - 09.2022
- Greet incoming patients, visitors and vendors and redirect them to proper area
- Collect patient information, and insurance information for registration process
- Analyze the patient’s insurance eligibility to confirm coverage, medical group and other specific needs pertaining to the date of service
- Follow up with assigned Medical Groups/Ipa regarding admission requests based on the patient’s needs
- Served as Lead in ER Registration, assisting with directing workflows
Patient Access Representative
Desert Valley Medical Center
08.2017 - 07.2019
- Greeted incoming patients, visitors, and vendors-redirected to proper areas
- Collected patient information regarding demographics and insurance information needed for billing purposes related to their hospital visit
- Analyzed the patient's insurance eligibility to confirm coverage, medical group, and other specifics needed that pertained to the date of service
- Assisted patients with applying for HPE
Patient Access Representative
Foothill Presbyterian Hospital
09.2013 - 09.2016
- Greeted incoming patients, visitors, and vendors-redirected to proper areas
- Collected patient information regarding demographics and insurance information needed for billing purposes related to their hospital visit
- Analyzed the patient's insurance eligibility to confirm coverage, medical group, and other specifics needed that pertained to the date of service
- Assisted patients with applying for HPE
- Registered patients for the following departments radiology, lab, emergency room, outpatient services, labor and delivery and nuclear medicine
- Served as Lead in ER Registration, assisting with directing workflows
Education
Medical Billing Specialist
MedCerts
06-2025
High School Diploma -
Victor Valley Adult Education
05.2021
Skills
- Leadership Skills
- Healthcare Documentation
- Insurance Billing
- HIPAA Compliance
- Authorization Processes
- Insurance Verification
Timeline
Financial Clearance Specialist III
Keck Medical Center of USC
08.2024 - Current
Senior Pre-Services Representative
Providence St Joseph Health/R1 RCM
12.2023 - Current
Lead Patient Access Representative
Providence St Mary Medical Center
08.2022 - 12.2023
Patient Access Representative
Pomona Valley Hospital Medical Center
05.2019 - 09.2022
Patient Access Representative
Desert Valley Medical Center
08.2017 - 07.2019
Patient Access Representative
Foothill Presbyterian Hospital
09.2013 - 09.2016
Medical Billing Specialist
MedCerts
High School Diploma -
Victor Valley Adult Education
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