Serena Johnson
Avondale,AZ
Summary
Results-driven Senior Provider Customer Service Representative at UnitedHealthcare, known for strong analytical skills and a dedication to team achievements or working independently, all without compromise on quality or accuracy. Proficient in resolving intricate inquiries while adhering to HIPAA regulations, significantly boosting provider satisfaction. Thrives in high-pressure environments, consistently delivering on established productivity, adherence, and quality standards.
Overview
8
8
years of professional experience
Work History
Senior Provider Customer Service Representative
United Healthcare
Phoenix, AZ
06.2022 - Current
- Provide excellent service and attention to health care providers through phone conversations.
- Depending on the provider's request, I often execute the pre-authorization, benefits, and/or eligibility process that's required for them to better treat their patients.
- Thoroughly research medical claims and appeal inquiries from providers for resolution.
- Help providers decipher relevant UHC medical policies regarding coverage or reimbursement.
- Demonstrate strong problem-solving skills, resolving issues efficiently and effectively on the first call.
- Follow HIPAA guidelines to ensure the confidentiality of provider and patient information.
- Recognized by management for providing exceptional customer service, and meeting monthly metrics.
- Volunteer for other projects as needed (e.g., I often assist with answering questions from fellow teammates in the Helix chat).
Patient Access Authorizing Specialist
BJC HealthCare
St. Louis, MO
12.2020 - 03.2022
- Contributed to patient care by helping our group of doctors execute the often tedious pre-authorization and eligibility process that is required before rendering many medical services.
- Verified the patient's medical coverage through their insurance carrier's website, through EPIC, or over the phone.
- I contacted the appropriate third-party entity (e.g., AIM, Evicore, Health Help, etc.) and confirmed whether an authorization is required for the requested service.
- I checked the status of already submitted requests.
- I contacted the appropriate doctor's office to notify them of the required authorization, updated them on previously submitted requests, and informed them when something else was needed for their pending requests (e.g., clinical notes, imaging reports, etc.).
- Volunteered for other projects as needed (e.g., participated in a 'brainstorming' group that came up with ideas to help improve system updates).
Operations Manager
Next Health Choice, LLC
Chicago, IL
01.2020 - 09.2020
- In addition to the responsibilities listed for Project Specialist (below), I orchestrated weekly refresher sessions that were designed to target and resolve problem areas within our operations team, which in turn resulted in more accurate coverage verifications and authorization submissions.
- I spearheaded daily morning 'Check-Ins' for the operations team that allowed team members to express their thoughts and/or feelings (work-related or personal) in a safe space during the Covid-19 pandemic.
- Met weekly with other managers to discuss training gaps or issues, efficiency, and overall workforce needs.
- Worked with the development team to discuss current updates and admin site changes.
- I made myself readily available to answer questions and assist the operators with any issues they may have encountered.
- Other duties and tasks as needed on a day-to-day basis.
Project Specialist
Next Health Choice, LLC
Chicago, IL
05.2018 - 12.2019
- Delivered exceptional service to our clients by handling the pre-authorization, benefits, and eligibility process that's required for them to better treat their patients.
- Verified the patient's medical coverage, eligibility, and benefits.
- Deciphered relevant medical policies for each procedure based on the payer and type.
- Analyzed submitted clinical notes from our clients, making sure they're relevant to the chosen CPT, HCPCS, and ICD-10 codes for each procedure.
- I volunteered for other projects as needed (e.g., researching clinical guidelines set forth by third-party authorizing entities like Evicore or AIM, making sure we obtain all of the necessary information from our clients in an effort to get all authorizations approved).
Education
Technical Diploma - Clinical Massage Therapy
The Soma Institute
Chicago, IL12.2015
Associates Degree - Fashion Design
IADT- Chicago
Chicago, IL05.2010
Diploma -
Hazelwood East High School
St Louis, MO05.2005
Skills
- Attention to detail
- Analytical thinking
- Research skills
- Problem solving
- Microsoft Office proficiency (Word, Outlook, PowerPoint, Excel, etc)
- Experience with ETS, ATS, ISET, Doc360 and other systems used by UHC
- Multitasking abilities
- Quick learner
- Medical policy interpretation
- Comprehension of medical terminology
- Dependable and responsible
- Effective communication
Volunteer Experience
American Heart Association - Heart Walk
St. Louis, MO - May 2023
Walker / Financial Donor
- Participated with my UHC team - Provider Services have Heart
Stone Temple Back to School & Health and Wellness Fair
Chicago, IL - August 2017 / August 2018 / August 2019
Massage Therapist
- Performed evaluation and treatment of fair goers who were interested in a more natural approach to pain relief.
The Bank Of America Chicago Marathon
Chicago, IL - October 2015 / October 2016 / October 2017 / October 2018
Massage Therapist
- Performed post-event evaluation and treatment of athletic participants.
Accomplishments
- I consistently meet and exceed the established UHC performance metrics for my position resulting in quarterly bonuses.
- After voluntarily helping fellow UHC teammates numerous times with questions and concerns in the Helix chat during the late shift, my supervisor officially offered me the opportunity to permanently help on the daily basis.
- Winner of my UHC team's team name competition with the highest number of votes. Team name: The Hackbarth A.D.A.P.T.E.R.S (Amazing Dedicated Advocates Providing a Top tier Experience Resulting in Success).
References
References available upon request.
Timeline
Senior Provider Customer Service Representative
United Healthcare
06.2022 - Current
Patient Access Authorizing Specialist
BJC HealthCare
12.2020 - 03.2022
Operations Manager
Next Health Choice, LLC
01.2020 - 09.2020
Project Specialist
Next Health Choice, LLC
05.2018 - 12.2019
Technical Diploma - Clinical Massage Therapy
The Soma Institute
Associates Degree - Fashion Design
IADT- Chicago
Diploma -
Hazelwood East High School