Summary
Overview
Work History
Education
Skills
Certification
Linkedin Certificates
Timeline
Generic

Sam Johnson

Dublin,OH

Summary

Health insurance professional skilled in multiple aspects of health plan benefit administration, including customer service, claims processing, and patient care coordination

Overview

9
9
years of professional experience
1
1
Certification

Work History

Patient Services Representative – Care Coordinator

Quantum Health
01.2022 - 01.2024
  • Provided customer service to members and providers through inbound/outbound calls, including verifying benefits, collecting and maintaining member eligibility information, creating prior authorizations based on member health plans, and processing appeal information
  • Served as patient advocate by coordinating care with plan network contacts, third-party administrators, clinical professionals, and finance staff at medical provider offices and hospitals
  • Collaborated with internal and external parties to solve client-initiated member eligibility issues
  • Communicated with insurance carriers and other third-party payers to investigate and resolve claim issues relating to member plan coverage (e.g Coordination of Benefits)

Advocate4me Representative | Benefit Advocate SME

United Healthcare
01.2020 - 01.2022
  • Provided customer service to members by explaining plan benefits and addressing members’ concerns about specific healthcare services

Instructor

University of Arkansas
01.2015 - 01.2020
  • Taught undergraduate philosophy courses emphasizing the development of analytical reading, critical thinking, and argumentation skills; responsible for course administrative functions including evaluations, planning and scheduling

Education

MA - philosophy

University of Mississippi
01.2014

BA - philosophy

Belhaven University
01.2012

Skills

  • CPT coding
  • ICD10 coding
  • Microsoft 365
  • Teams
  • Word
  • Excel
  • PowerPoint
  • PIVIT
  • Pega 8
  • IEX Webstation
  • Genesys
  • Neidia
  • Qualtrics
  • Power BI
  • Written communication
  • Oral communication
  • Organizational skills
  • Time management
  • Research skills
  • Fact-checking
  • Information analysis
  • Documents/forms review
  • Handling personal health information
  • HIPAA
  • Handling appeals
  • Handling grievances

Certification

  • Lean Six Sigma Green Belt, Six Sigma Online; Aveta Business Institute, 01/01/24, Y2EyNTM2NTQtNzA4Nzk
  • Lean Six Sigma Yellow Belt, Six Sigma Online; Aveta Business Institute, 01/01/24, Y2EyNTM2NTQtNjkzMzM
  • Microsoft Excel – Excel from Beginner to Advanced, Udemy, 12/01/23, UC-a5b4070f-db32-4c8e-9bf5-2aafb6e30bf3

Linkedin Certificates

  • Business Analysis Foundations: Business Process Modeling
  • Business Process Improvement
  • Creating Flowcharts for Beginners
  • Scrum The Basics
  • Software Project Management Foundations
  • Agile Project Leadership
  • Agile Project Management Foundation

Timeline

Patient Services Representative – Care Coordinator

Quantum Health
01.2022 - 01.2024

Advocate4me Representative | Benefit Advocate SME

United Healthcare
01.2020 - 01.2022

Instructor

University of Arkansas
01.2015 - 01.2020

BA - philosophy

Belhaven University

MA - philosophy

University of Mississippi

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Sam Johnson