Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Mykenaia Johnson

North Little Rock,AR

Summary

Health Specialist with education and experience in clinical operations and healthcare delivery, supporting organizational implementation and maintenance of health delivery regulatory compliance and best practices. Develop policies and procedures, standard work and educational materials for providers. Serve as lead resource during compliance audits.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Referral Specialist

Centene
07.2019 - Current

    • Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
    • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
    • Responded to inquiries from healthcare providers regarding prior authorization requests.
    • Verified eligibility and compliance with authorization requirements for service providers.
    • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
    • Developed and maintained productive working relationships with healthcare providers.
    • Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
    • Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
    • Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
    • Filed and maintained patient records in accordance with HIPAA regulations.
    • Communicated with production team members about quality issues.
    • Followed all company policies and procedures to deliver quality work.
    • Maintained consistent follow-up on status of prior authorization requests.
    • Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.
    • Completed form letters in response to requests or problems identified by correspondence.
    • Read incoming correspondence to ascertain nature of writers' concerns and to determine disposition of correspondence.

Medical Receptionist/Front Desk

Arkansas Urology
08.2018 - 07.2019
    • Coordinated patient scheduling, check-in, check-out and payments for billing.
    • Adhered to strict HIPAA guidelines to protect patient privacy.
    • Managed multi-line phone system and pleasantly greeted patients.
    • Checked patient insurance, demographic, and health history to keep information current.
    • Helped patients complete necessary medical forms and documentation.
    • Organized paperwork such as charts and reports for office and patient needs.
    • Maintained current and accurate medical records for patients.
    • Supported office staff and operational requirements with administrative tasks.
    • Transcribed phone messages and relayed to appropriate personnel.
    • Kept waiting room neat and organized by stacking magazines, removing trash, and cleaning glass.
    • Completed patient referrals to other medical specialists.
    • Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
    • Invoiced patients accurately in line with charging guidelines.
    • Notified manager of incidents and potential incidents relating to patients and staff for swift action.
    • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
    • Performed various administrative tasks by filing, copying and faxing documents.

Patient Representative

Call Center
02.2018 - 11.2018
    • Verified any changes or data updates to patient records and checked insurance information at each appointment.
    • Reviewed and solved account and billing discrepancies.
    • Assessed accounts for payment status and reached out to patients.
    • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
    • Received incoming information and entered into database system.
    • Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
    • Researched and resolved billing discrepancies to enable accurate billing.
    • Worked with multiple departments to check proper billing information.
    • Processed and verified invoices to secure accuracy of billing information.
    • Provided excellent customer service, developing and maintaining client relationships.

Medical Receptionist

Health Care for Women
09.2016 - 09.2017
    • Checked patient insurance, demographic, and health history to keep information current.
    • Adhered to strict HIPAA guidelines to protect patient privacy.
    • Helped patients complete necessary medical forms and documentation.
    • Managed multi-line phone system and pleasantly greeted patients.
    • Organized paperwork such as charts and reports for office and patient needs.
    • Maintained current and accurate medical records for patients.
    • Kept waiting room neat and organized by stacking magazines, removing trash, and cleaning glass.
    • Transcribed phone messages and relayed to appropriate personnel.
    • Communicated with insurance providers to resolve denied claims and resubmitted.
    • Located errors and promptly refiled rejected claims.
    • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
    • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
    • Filed and updated patient information and medical records.
    • Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.

Nurse Assistant / Information Associate

Baptist Hospital
05.2015 - 10.2016
    • Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
    • Promoted good oral and personal hygiene by aiding patients with shaving, bathing, and teeth brushing.
    • Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
    • Helped patients effectively manage routine bathing, grooming, and other hygiene needs.
    • Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
    • Reported unusual or urgent circumstances in patients' condition or environment immediately to nurse supervisor.
    • Agreed to take on additional shifts and extra hours during busy periods and holidays to maintain proper staffing and floor coverage.
    • Maximized patient satisfaction by helping individuals carry out personal tasks such as dressing and walking.
    • Wiped down equipment with proper cleaning products after each patient transport to reduce instances of infection.
    • Evaluated patients' progress in treatment, communicating observations to physician on duty to maintain or adjust prescribed care.
    • Educated patients and family members on best home care practices for healing and recovery.

Bank Teller / Customer Service

Bank Of The Ozarks
02.2016 - 08.2016
  • Answered customer inquiries regarding account balances, transaction history, services charges, and interest rates.
  • Processed customer transactions promptly, minimizing wait times.
  • Built and strengthened customer relationships by leveraging excellent interpersonal and communication skills.
  • Completed highly accurate, high-volume money counts via both manual and machine-driven approaches.
  • Provided customer records, account statements and copies of checks.
  • Counted and packaged currency and coins.
  • Reconciled cash drawer and resolved discrepancies.
  • Answered telephone inquiries on checking and savings accounts, loans, and lines of credit.
  • Learned about customer's financial needs, established trust, and optimized sales opportunities resulting in quality customer service.
  • Educated customers on use of banking website and mobile apps.
  • Logged cashier's checks and other transactions to maintain accurate account records.
  • Assisted customers with compromised debit cards and issued new credentials.
  • Answered customer inquiries regarding account balances, transaction history, services charges, and interest rates

Education

Associate of Science - Health Science

Ultimate Medical Academy
Florida
01.2017

Diploma - Medical Administrative Assistant

Ultimate Medical Academy
Flordia
01.2016

Skills

    • Billing
    • Receptionist
    • Filing
    • Data Entry
    • Scheduling
    • Clerical
    • Inventory
    • Management
    • Microsoft
    • Microsoft Office
    • Microsoft Word
    • Organizational Skills
    • Outlook
    • CPT Coding
    • ICD-10
    • Anatomy Knowledge
    • Medical Terminology
    • Medical Office Experience
    • Insurance Verification
    • Documentation review
    • Medical Scheduling
    • EMR Systems
    • Patient Care
    • Medical Billing
    • Medical documentation
    • Windows
    • Epic
    • Computer literacy
      • Customer service
      • Multi-line phone systems
      • Microsoft Excel
      • Office experience
      • Administrative experience
      • English
      • Typing
      • Human resources
      • Accounts payable
      • Payroll
      • ICD-9
      • Medical Receptionist
      • Transcription
      • Triage
      • HIPAA
      • Nursing
      • Physiology Knowledge
      • SharePoint
      • Home care
      • Medicare
      • HEDIS
      • Case management
      • Medical Records
      • Records Management
      • ICD Coding
      • Phone Etiquette
      • Accounting
      • Medical Coding

Certification

CPR Certification

Timeline

Referral Specialist

Centene
07.2019 - Current

Medical Receptionist/Front Desk

Arkansas Urology
08.2018 - 07.2019

Patient Representative

Call Center
02.2018 - 11.2018

Medical Receptionist

Health Care for Women
09.2016 - 09.2017

Bank Teller / Customer Service

Bank Of The Ozarks
02.2016 - 08.2016

Nurse Assistant / Information Associate

Baptist Hospital
05.2015 - 10.2016

Associate of Science - Health Science

Ultimate Medical Academy

Diploma - Medical Administrative Assistant

Ultimate Medical Academy

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Mykenaia Johnson