Shakila Johnson
Atlanta,GA
Summary
Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Specialist
State Farm
01.2024 - Current
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Increased productivity by streamlining claim processing procedures and implementing time-saving technologies.
- Supported long-term business planning by providing key insights from claim data analysis to inform strategic decision-making processes within the organization.
- Strengthened client relationships by providing clear communication throughout the claims process, ensuring all parties were well-informed of progress and outcomes.
- Maintained compliance with industry regulations and standards by staying current on relevant laws, policies, and best practices for handling insurance claims.
Compliance Analyst/Tax Examiner I
Georgia Department Of Revenue
11.2022 - 01.2024
- Verify taxpayer data and ensure completeness and accuracy of supporting documentation for alcohol and tobacco tax types including brand registrations, COLAS, beer/wine, wholesalers, distributors, brokers and many more
- Review forms, providing assistance to taxpayers regarding licensing and registration, and offering guidance on applicable laws and regulations
- Complete licensing and registrations in accordance with standard procedures
- Analyze multiple reports and concurrent applications to propose suggestions for resolving potential and complex issues in 100 monthly cases
- Researched state laws, regulations, and department guidelines, confirmed compliance with organizational rules and guaranteed admirable delivery of auditing services
- Directed and guided quality review functions associated with internal auditing, investigations, risk analysis, and database management, while verifying all operational and administrative activities comply with company guidelines
- Communicate with customers and/or their accounting or legal representatives to initiate audits and obtain necessary records
- Train customers on applicable laws, regulations, and audit procedures and policies.
Sr. Patient Access Specialist (remote)
Vanderbilt University Medical Center
02.2021 - 10.2022
- Compiled and maintained patient medical records to keep information complete and up-to-date.
- Partnered with billing teams identifying areas of improvement within the department reducing total outstanding balances.
- Contacted insurance companies for patient medical billing operations.
- Verified insurance coverage and obtained necessary authorizations to ensure timely billing and reimbursement.
Medical Screener (Temp)
Keys Medical Staffing LLC
07.2020 - 12.2020
- Answered questions and provided appropriate assistance and communication to callers.
- Maintained up-to-date knowledge of industry best practices, ensuring high-quality care for all patients served.
- Educated patients on the importance of routine screenings, promoting preventative healthcare practices within the community.
- Conducted basic screening procedures to verify compliance with donation criteria.
Project Manager, Referrals
Massachusetts General Hospital
02.2019 - 06.2020
- Verified quality of deliverables and conformance to specifications before submitting to clients.
- Developed and implemented strategic project plans to meet business objectives.
- Facilitated change management processes within organizations by effectively communicating benefits of new systems or processes being introduced during projects.
- Fostered a culture of innovation and creativity within the project team, leading to improved problem-solving capabilities and enhanced outcomes.
Education
Associate of Arts - Interdisciplinary Studies
Atlanta Technical College
Atlanta, GA05.2026
Certificate - Medical Assisting
Southeastern Technical College
South Easton, MA06.2020
Skills
- Compliance
- Risk Mitigation
- Project Management
- Regulatory Compliance
- Reporting
- Auditing and documentation
- Data Analysis
- Training
- Customer Support
- Documentation skills
- Claims analysis
- Policy and Procedure Writing
References
References available upon request
Certification
- Licensed Claims Adjuster
- CMA - Certified Medical Assistant
Timeline
Claims Specialist
State Farm
01.2024 - Current
Compliance Analyst/Tax Examiner I
Georgia Department Of Revenue
11.2022 - 01.2024
Sr. Patient Access Specialist (remote)
Vanderbilt University Medical Center
02.2021 - 10.2022
Medical Screener (Temp)
Keys Medical Staffing LLC
07.2020 - 12.2020
Project Manager, Referrals
Massachusetts General Hospital
02.2019 - 06.2020
Associate of Arts - Interdisciplinary Studies
Atlanta Technical College
Certificate - Medical Assisting
Southeastern Technical College
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