REINA YSOBEL C. JOHNSON
Abilene,TX
Summary
Experienced professional with strong investigative skills and a proven track record of delivering accurate data. Utilizes analytical qualities to identify issues and provide effective solutions. Proactive and goal-oriented with excellent time management and problem-solving skills. Recognized for reliability and adaptability, with a quick capacity to learn and apply new skills. Committed to driving team success and contributing to organizational growth through leveraging these qualities.
Overview
20
20
years of professional experience
Work History
FEP Audit Recovery Specialist
Blue Cross Blue Shield of TX - HCSC
01.2021 - Current
- Researched and Analyzed Focus Audits, Team Tracks, Specialty Drug Projects, monthly System Wide Reports, Duplicates, Uncoordinated Medicare for discrepancies in coding; coordination of benefits; validated coding; repriced post-paid claims for additional payments or overpayments that led to refunds or recoupment.
- Coordinated Federal Audits conducted by Blue Cross Blue Shield Association (BCBCSA) and Office of Personnel Management (OPM) as well as internal audits of providers not covered by external reviewers.
- Participated in Focus Group tasked with creating process workflows that is proprietary for Audit Recovery Unit.
- Constructed Enhanced Overpayment Excel Sheet for efficient auditing purposes.
- Improved existing guidelines used company wide.
- Collaborated in September System Focus Group with Kevin Taylor.
- Maintained Exceeded or Significantly Exceeded Performance Review rating every year.
- Surpassed goal for Overpayment Recovery average of 1-2 business days for 2024 Year to date for combined 5 states.
Senior Claim Technician - PASS UNIT
Blue Cross Blue Shield of TX - HCSC
03.2020 - 01.2021
- Re-analyzed and processed Customer Service and Claims PASS projects in timely manner.
- Provided clear, analytical responses to providers and other departments based on workflow process.
- Provided support as needed within the department.
Customer Advocate II
Blue Cross Blue Shield of TX - HCSC
01.2009 - 03.2020
- Processed written inquiries for Federal Employee Program from members and providers thru scanned correspondence or thru Claim Inquiry Resolution for 7 years.
- Assisted members by understanding their medical needs and guiding them through details of their claims.
- Evaluated provider submissions and reconciled them with BCBS policy and guidelines.
- Finalized claims for both member and providers by adjusting and processing submitted claims, work Deferrals, and COB related issues.
- Trained personnel for 2 years as Learning Coach.
- Earned 'Exceedingly met goals' consistently on evaluations thru career at Blue Cross Blue Shield.
- Handled difficult customer situations with grace and professionalism, consistently meeting first-call resolution metrics.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
Officer-in-Charge (Pre-Operational Period)
Itouchpoint Softech Pvt. Ltd.
06.2004 - 06.2007
- Provided training, coaching and mentoring to employees.
- Reported personnel growth and performance reports to the Overseeing Manager of the Pre-Operational Period Process.
- Developed and executed performance management programs to increase employee engagement and productivity.
Assistant Supervisor (Directory Assistance)
Itouchpoint Softech Pvt. Ltd.
06.2004 - 06.2007
- Managed and produced team reports for productivity and quality.
- Worked with management team to implement proper division of responsibilities.
- Revised work practices to improve efficiency, boost quality and meet production goals.
- Supported Supervisor by preparing production reports and collating quality documentation.
Education
Medical Office Specialist Certificate 2 (HIT)
Texas State Technical College - West Texas
Abilene, TX01.2019
Health Information Technology
Texas State Technical College - West Texas
Abilene, TX01.2013
Skills
- Financial Suspense System, Premier Pricing, and Claims Audit Monitoring Tool
- Proficient in Word, Excel, OneNote, and PowerPoint
- Consistent 100% Accuracy Quality score
- Problem-solving skills
- Analytical and organizational skills
- Ability to meet deadlines
- Teamwork and Collaboration
- Adaptability and Flexibility
- Strong written and communication skills
- Attention to Detail
- CPT coding knowledge and medical terminology
Training
- Streamline GUI adjustment/ Mass adjustments
- FSS Web Automation
- Deferral
- Dental
- Refund process 1510/1527
- Coordination of Benefits
- Durable Medical Equipment
- Premier pricing
- Plan Approval
- Claims GUI
- SmartUM/ARIS
- IL Subshare
- Manual Calculations
- FEPDirect
Timeline
FEP Audit Recovery Specialist
Blue Cross Blue Shield of TX - HCSC
01.2021 - Current
Senior Claim Technician - PASS UNIT
Blue Cross Blue Shield of TX - HCSC
03.2020 - 01.2021
Customer Advocate II
Blue Cross Blue Shield of TX - HCSC
01.2009 - 03.2020
Officer-in-Charge (Pre-Operational Period)
Itouchpoint Softech Pvt. Ltd.
06.2004 - 06.2007
Assistant Supervisor (Directory Assistance)
Itouchpoint Softech Pvt. Ltd.
06.2004 - 06.2007
Medical Office Specialist Certificate 2 (HIT)
Texas State Technical College - West Texas
Health Information Technology
Texas State Technical College - West Texas
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