Renee C. Johnson
Healthcare/Administrative
Manchester,CT
Summary
Detail-oriented and professional individual with exceptional customer service and interpersonal skills. Strong organizational and planning capabilities. Proven track record of effective communication with individuals at all levels within an organization. Skilled at multitasking and managing multiple priorities simultaneously. Capable of working independently or collaboratively with a team to ensure timely project completion.
Overview
20
20
years of professional experience
Work History
Customer Solutions Expert II – Verifications Associate/Claim Service Center
CARECENTRIX
01.2010 - 05.2025
- Responsible for verifying patient’s insurance coverage, to ensure claims are processed correctly as well as handling insurance-related inquiries. Communicates with the insurance company, patient and healthcare providers to obtain necessary information and resolve issues related to insurance coverage.
- Thorough understanding of different insurance plans and coverage details
- Strong communication and customer service skills to work closely with patient, insurance providers
- Verify patient insurance and update records accordingly
- Communicate with insurance companies to obtain benefit information
- Maintain patient confidentiality and adhere to HIPAA regulations
Claims Adjudicator/RCM Claims Support
CARECENTRIX
08.2010 - 01.2018
- Review, investigate and process DME (durable medical equipment) claims into Carecentrix systems. Match claims data with the appropriate authorizations. Determines correct claims payment or denial. Identify and evaluate questionable claims and authorizations or system issues as appropriate.
- Review health plan eligibility, patient notes and authorizations to determine appropriate adjudication. Create authorizations when necessary based on individual provider and health plan contract.
- Review electronic claims or processes data as necessary into the claim system, resolves computer generated edit conditions, and determine correct payment or denial amounts as well as document notes as appropriate.
- Identify and refers questionable claims, intakes, authorization, and system issues to appropriate Senior Claims Analyst and then respond accordingly.
- Researches and, if necessary, process claim payment adjustments resulting from customer service referrals, audits or data inaccuracies as detected.
- Exercise good judgment, interprets medical claim data and contracts, and remains knowledgeable in related company policies and procedures.
- Achieves teamwork, production and quality standards in order to assure timely, efficient and accurate claims processing.
- Maintains patient confidentiality and claims integrity in accordance with company policy and procedures.
- Adheres to and participates in mandatory HPPA privacy program/practices and business ethics and compliance program/practices. Understand Utilization Management and URAC standards and ensures policies and procedures are followed.
Overpayment / Recovery Claims Processor
CIGNA HEALTHCARE
01.2005 - 01.2009
- Examined and processed voluntarily returned refund checks as well as demand and correspondence request refunds from beneficiaries / providers
- Effectively communicated any issues/concerns with customers regarding refund checks, both orally and in writing. Analyzed cases and adjusted claims as needed.
- Accessed multiple computer applications to obtain information to assist in case reviews and recommended appropriate action to resolve.
- Monitored workflow to ensure turn-around times were met.
- Processed claims accurately meeting or exceeding timelines.
Education
Associate Degree - Science
- The Garlinghouse Co. – Corporate Education
- Successful Sales through Service, 2004
- TLC for VIP's (Telephone Skills Workshop), 2002
- The Hartford Insurance Co., Corporate Education, 1990 – 2001
- Career Awareness Seminar
- Time Management
- Giving and Getting Feedback
- Professionalism in the Office
- Effective Communication Skills
- Valuing Human Diversity
- Writing that Works
- INTRO (Introduction to Property and Liability Insurance – IIA)
- Introduction to Claims – IIA (Insurance Institute of America)
Skills
- Office administration expertise
- Strong interpersonal communication
- Skilled in customer engagement
- Skilled in Microsoft Office
- Strong oral and written communication
- Effective multi-tasking
- Advanced mathematical skills
- Adaptability to change
Timeline
Claims Adjudicator/RCM Claims Support - CARECENTRIX
08.2010 - 01.2018
Customer Solutions Expert II – Verifications Associate/Claim Service Center - CARECENTRIX
01.2010 - 05.2025
Overpayment / Recovery Claims Processor - CIGNA HEALTHCARE
01.2005 - 01.2009
Capital Community State College - Associate Degree, Science
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