SIERRA JOHNSON
Elk Grove,CA
Summary
Detail-oriented Medical Customer Service Professional with over 11 years of experience, including 1 year in utilization management. Skilled in verifying eligibility, coordinating prior authorizations, and resolving inquiries to ensure efficient patient and provider support. Proven ability to review request completeness and route clinical cases for timely authorization decisions, demonstrating adaptability and commitment to continuous learning.
Overview
12
12
years of professional experience
Work History
Customer Service Representative / Utilization Management Coordinator II
Vivant Health
Sacramento, CA
03.2024 - 08.2026
- Supported healthcare providers and members with eligibility verification, benefits interpretation, prior authorization requirements, and authorization status inquiries.
- Coordinated with members, providers, and internal utilization management teams to resolve authorization denials, eligibility discrepancies, and coverage gaps.
- Verified member demographics, insurance coverage, eligibility, and other information needed for accurate processing.
- Reviewed prior authorization requests for clinical documentation completeness and routed to appropriate clinical or operational queues based on urgency and service type.
- Recreated and updated authorization requests following corrections and additional processing.
- Helped providers navigate healthcare portals and understand authorization submission requirements.
- Documented case notes in compliance with HIPAA, escalated urgent authorization requests to clinical reviewers, and maintained accurate member demographic records.
Customer Service Representative / Chat Support
TTEC
Sacramento, California
08.2021 - 03.2024
- Handled customer inquiries via telephone and chat, researching information to effectively resolve concerns.
- Resolved customer complaints through effective problem-solving techniques.
- Navigated high-stress situations, documented resolutions, and managed multiple conversations while maintaining quality standards.
Customer Service Representative / Team Lead
Faneuil Blue Cross Blue Shield of Michigan
Sacramento, CA
11.2019 - 08.2021
- Handled high-volume healthcare calls on claims adjudication, eligibility verification, covered benefits, authorization status, and member portal navigation, ensuring accurate information delivery.
- Resolved complex customer inquiries and escalated issues to appropriate departments.
- Researched claim-payment discrepancies, routed adjustment cases for reprocessing, and mentored team members on escalation handling and complex case procedures.
- Trained new representatives on policies and procedures for effective service delivery.
Customer Service Representative
Kelly Services Health Net/Centene
Sacramento, CA
05.2019 - 09.2019
- Provided exceptional customer support through phone, email, and chat channels.
- Resolved complex inquiries efficiently while maintaining a positive customer experience.
- Addressed inquiries through telephone and written correspondence while accurately documenting interactions in CRM system.
- Guided members and providers in navigating portal, understanding health plan programs, and accessing benefits and account information.
- Collaborated with team members to streamline service processes and improve response times.
Customer Service Representative / Team Lead
Faneuil Covered California
Sacramento, CA
09.2017 - 01.2019
- Managed inbound and outbound calls to assist consumers with health coverage enrollment and resolve escalated cases effectively.
- Conducted coaching sessions for customer service representatives on enrollment procedures, escalation protocols, and quality standards across telephone, chat, and email channels to enhance team knowledge.
Medical Assistant / Front Office
Family Planning Associates
Sacramento, CA
11.2016 - 07.2017
- Scheduled patient appointments, charted vital signs in EHR, and guided patients on pre-procedure preparation and post-visit care to ensure informed patient experience.
- Verified patient insurance information for accuracy and maintained HIPAA-compliant records to support efficient front-office operations.
- Assisted patients with medical history and intake forms.
- Prepared examination rooms and ensured cleanliness and organization.
- Supported healthcare providers during patient examinations and procedures.
Caregiver
Greenhaven Estates
Sacramento, CA
06.2016 - 11.2016
- Provided personal care to residents, ensuring dignity and comfort during bathing, grooming, dressing, and safe wheelchair transfers.
- Monitored residents' health changes, relayed critical information to families and care teams, and offered emotional support to enhance overall well-being.
- Provided companionship and emotional support to enhance resident well-being.
- Maintained accurate records of resident care and health status updates.
Customer Service Representative
AppleOne Maximus
Folsom, CA
10.2014 - 01.2016
- Assisted customers with inquiries regarding health insurance plans and benefits.
- Resolved complaints and routed cases, documenting interactions and enrollment details to maintain clear records.
- Conducted inbound and outbound calls to enroll beneficiaries in managed care plans, ensuring accurate processing of information.
Education
Medical Assistant Certificate -
10-2016
High School Diploma -
Hiram Johnson High School
Sacramento, CASkills
- Utilization management
- Claims handling
- Member services
- Patient coordination
- Contact center operations
- Quality assurance
- Telephone systems
- Typing proficiency
- Time optimization
- Problem solving
- Effective communication
- Authorization review
- Electronic health records
- Healthcare compliance
Personal Information
Title: Utilization Management Coordinator | Prior Authorization Coordinator, Member Services, Healthcare Navigation
Timeline
Customer Service Representative / Utilization Management Coordinator II
Vivant Health
03.2024 - 08.2026
Customer Service Representative / Chat Support
TTEC
08.2021 - 03.2024
Customer Service Representative / Team Lead
Faneuil Blue Cross Blue Shield of Michigan
11.2019 - 08.2021
Customer Service Representative
Kelly Services Health Net/Centene
05.2019 - 09.2019
Customer Service Representative / Team Lead
Faneuil Covered California
09.2017 - 01.2019
Medical Assistant / Front Office
Family Planning Associates
11.2016 - 07.2017
Caregiver
Greenhaven Estates
06.2016 - 11.2016
Customer Service Representative
AppleOne Maximus
10.2014 - 01.2016
Medical Assistant Certificate -
High School Diploma -
Hiram Johnson High School