Rhonda Johnson

• Manage follow-up on approximately 40+ cases/claims daily across Medicare, Medicaid, and commercial payers
• Provide inbound and outbound communication with physician offices, insurance representatives, and internal teams
• Investigate and resolve denials, underpayments, and aging accounts from initiation through resolution
• Submit corrected claims and detailed appeals to government and commercial payers
• Maintain detailed documentation and case tracking to ensure workflow visibility
• Analyze aging reports and prioritize accounts to prevent timely filing losses
• Post ERA/EFT payments and process necessary adjustments and refunds
• Collaborate with cross-functional teams to ensure timely case completion
• Consistently meet productivity and quality standards in a fully remote environment
• Work directly with payer portals and insurance representatives to verify claim status, eligibility, authorizations, and payment accuracy.
• Analyze EOBs, remittance advice, and payer policies to identify trends and prevent future denials.
• Research coding, modifier, diagnosis, and medical necessity issues related to ophthalmology and retina services.
• Collaborate with providers, billing departments, and management to improve reimbursement and reduce aging balances.
• Maintain detailed documentation of claim activity, follow-up actions, and payer communication.
• Use strong problem-solving skills to resolve complex claim issues and maximize revenue recovery.

• Reconciled daily financial transactions including insurance and patient payments
• Researched and resolved payment discrepancies and credit balances
• Processed insurance and patient refunds in compliance with payer guidelines
• Assisted with month-end reconciliation and financial reporting
• Collaborated with billing and accounting teams to ensure financial accuracy
• Followed up on unpaid, denied, or partially paid claims with commercial and government insurance payers.
• Researched payer guidelines and corrected claim errors involving CPT, ICD-10, modifiers, and demographics.
• Submitted appeals and supporting documentation to obtain claim reimbursement.
• Worked insurance aging reports and maintained organized account notes and documentation.
• Ensured compliance with HIPAA regulations and payer billing guidelines.
• Followed up on unpaid, denied, or partially paid claims with commercial and government insurance payers.
• Managed insurance claims from submission through payment posting and collections.
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• Performed full-cycle A/R including payment posting, claim follow-up, and denial management
• Submitted appeals and supporting documentation to obtain claim reimbursement.
• Generated and analyzed aging reports to reduce outstanding balances
• Reviewed EOBs to identify underpayments and billing discrepancies
• Maintained HIPAA compliance and audit-ready documentation
• Handle approximately 40 claims per day while maintaining productivity and accuracy standards.
• Maintain detailed documentation of claim activity, follow-up actions, and payer communication.
• Followed up on unpaid, denied, or partially paid claims with commercial and government insurance payers.

• Served as the sole insurance coordinator and biller for a busy eye care practice, handling all day-to-day billing and insurance responsibilities independently.
• Managed the full revenue cycle process from patient scheduling and insurance verification through claim payment and account resolution.
• Verified insurance eligibility, benefits, referrals, authorizations, copays, deductibles, and secondary insurance coverage before patient appointments.
• Reviewed patient charts, diagnosis codes, procedure codes, modifiers, and physician documentation for billing accuracy.
• Submitted claims electronically and manually to Medicare, Medicaid, vision plans, and commercial insurance companies.
• Worked denied, rejected, and unpaid claims by correcting errors, rebilling claims, and submitting appeals with supporting documentation.
• Posted insurance payments, patient payments, adjustments, refunds, and contractual write-offs into the billing system.
• Reviewed explanation of benefits (EOBs), remittance advice, and payer correspondence to ensure accurate reimbursement.
• Balanced daily deposits, charges, and payment reports to maintain billing accuracy.
• Assisted patients with insurance questions, payment arrangements, balances, and explanation of coverage.
• Coordinated with doctors, technicians, and front office staff to resolve billing, coding, and reimbursement issues.
• Maintained organized patient account notes, claim status updates, and insurance documentation.
• Ensured compliance with HIPAA regulations and payer-specific billing guidelines.Successfully managed all insurance and billing duties as a one-person department for a practice averaging approximately 15–19 patients per day.
• Trained staff on billing workflows and system usage

• Began as a medical biller for a high-volume neuro-ophthalmology practice seeing approximately 80–90 patients per day for one provider.
• Managed daily charge entry, claim submission, payment posting, and accounts receivable follow-up for office visits, diagnostic testing, procedures, and neuro-ophthalmology services.
• Reviewed patient charts, physician documentation, diagnosis codes, CPT codes, modifiers, and demographics to ensure accurate claim submission.
• Submitted claims electronically and manually to Medicare, Medicaid, commercial insurance plans, and specialty vision carriers.
• Worked denied, rejected, and unpaid claims by correcting billing errors, obtaining missing information, and resubmitting claims.
• Submitted appeals, reconsiderations, corrected claims, and supporting medical documentation to insurance companies for denied services.
• Reviewed explanation of benefits (EOBs), remittance advice, and payer correspondence to verify correct reimbursement and identify underpayments.
• Posted insurance payments, patient payments, contractual adjustments, refunds, and write-offs into the billing system.
• Maintained detailed account notes, claim status updates, and follow-up documentation on all patient accounts.
• Contacted insurance companies directly to resolve claim issues, verify benefits, obtain claim status, and research payment discrepancies.
• Assisted patients with billing questions, payment arrangements, insurance balances, and collections.
• Performed patient collections by following up on outstanding balances, setting up payment plans, sending statements, and collecting overdue balances.
• Worked closely with front office staff and providers to resolve insurance issues, coding concerns, and missing documentation. Credentialing Duties:
• Learned and managed the provider credentialing process for commercial insurance companies, Medicare, Medicaid, and hospital affiliations.
• Prepared and submitted provider applications, CAQH updates, state license renewals, malpractice insurance documents, DEA information, and supporting credentialing paperwork.
• Monitored expiration dates for licenses, certifications, malpractice insurance, hospital privileges, and payer enrollments to ensure compliance.
• Maintained accurate credentialing files and tracked application statuses with insurance companies and facilities.
• Communicated with provider representatives, insurance networks, and credentialing departments to resolve enrollment delays and missing documentation.
• Ensured timely completion of provider reappointments, revalidations, and recredentialing requirements.

Insurance Recredentialing / Contract Negotiation Duties:

• Promoted into an insurance recredentialing role due to knowledge of payer enrollment processes and strong insurance relations experience.
• Managed recredentialing and contract renewal processes for all insurance plans to ensure uninterrupted provider participation.
• Reviewed payer contracts, reimbursement rates, fee schedules, and plan participation terms during renewal periods.
• Negotiated reimbursement rates and contract terms with insurance companies during payer renewals to improve revenue and maintain favorable participation agreements.
• Followed up with payer representatives regarding contract renewals, provider status updates, and network participation changes.
• Maintained organized records of all contracts, renewal deadlines, fee schedules, and payer agreements.
• Assisted leadership with evaluating which insurance plans were financially beneficial for the practice to maintain or renegotiate.
• Played a key role in ensuring the provider remained active and credentialed with all major insurance networks for continued patient access and reimbursement.