Summary
Overview
Work History
Education
Skills
Languages
References
Timeline
Generic

Tania Johnson

Wesley Chapel

Summary

Motivated professional with a strong work ethic and adaptability in dynamic environments. Proven ability to work independently and quickly acquire new skills. Committed to enhancing office efficiency through effective contributions and innovative solutions.

Overview

10
10
years of professional experience

Work History

Eligibility & Authorization

TGH Imaging Powered by Tower
Tampa
08.2024 - Current
  • Reviewed patient records to ensure accuracy of demographic information and insurance eligibility.
  • Verified patient information through insurance eligibility checks.
  • Verified insurance eligibility for referred services using online databases and contacted insurers directly when needed.
  • Verified patient insurance eligibility prior to the procedure.
  • Performed data entry into various computer systems including but not limited to EMRs and CRMs.
  • Verified insurance authorizations with payers via telephone or web-based systems.
  • Reviewed authorization requests for accuracy and completeness.
  • Tracked authorization statuses using electronic databases or manual filing systems.
  • Coordinated communication between providers, patients, payers, and other departments as needed.
  • Participated in meetings with staff members from other departments such as billing and coding teams to provide clarification on policies related to authorizations.
  • Conducted follow-up calls to confirm receipt of required documents from healthcare providers.
  • Processed electronic authorizations in accordance with established policies and procedures.

Medicaid Room & Board Biller

Gulfside Healthcare Services
Land O Lakes
04.2023 - 08.2024
  • Collaborated with other departments such as the clinical staff to obtain necessary documentation for processing claims accurately.
  • Performed daily follow-up on outstanding claims to ensure prompt payment from payers.
  • Prepared detailed claims for submission to insurance companies according to policy guidelines.
  • Documented all account activity into electronic medical record system ensuring accuracy of data entry.
  • Participated in training sessions related to new policies and procedures as well as updates on existing ones.
  • Maintained up-to-date records of all billing activities including charges, adjustments, denials, and collections.
  • Conducted regular audits of delinquent accounts to identify any potential problems or areas needing improvement.
  • Generated monthly reports to document financial status of accounts receivable.
  • Coordinated with third-party payers concerning authorization requests, coding changes, and payment disputes.

Insurance Eligibility & Authorization

Florida Pain Management Center
Wesley Chapel
02.2022 - 03.2023
  • Assessed insurance benefits and determined eligibility criteria.
  • Communicated with internal teams regarding changes in policy or procedure related to prior authorization process.
  • Identified opportunities for improvement in existing processes and procedures related to prior authorizations.
  • Researched medical policies to ensure appropriate coverage of services.
  • Processed appeals for denials in accordance with established procedures.
  • Responded promptly to inquiries from providers, members, and other departments within the organization.
  • Provided timely feedback to physicians regarding authorization status.
  • Reviewed prior authorization requests for completeness and accuracy.
  • Facilitated communication between health plan representatives, providers, and members when needed.
  • Provided support by answering inquiries related to the authorization process.
  • Maintained current knowledge of changes within the healthcare industry related to the prior authorization process.
  • Identified potential problems or discrepancies within the authorization process.

Prior Authorization Specialist

Tower Radiology
Tampa
03.2018 - 02.2022
  • Assessed insurance benefits and determined eligibility criteria.
  • Communicated with internal teams regarding changes in policy or procedure related to prior authorization process.
  • Identified opportunities for improvement in existing processes and procedures related to prior authorizations.
  • Researched medical policies to ensure appropriate coverage of services.
  • Processed appeals for denials in accordance with established procedures.
  • Responded promptly to inquiries from providers, members, and other departments within the organization.
  • Provided timely feedback to physicians regarding authorization status.
  • Reviewed prior authorization requests for completeness and accuracy.
  • Facilitated communication between health plan representatives, providers, and members when needed.
  • Provided support by answering inquiries related to the authorization process.
  • Maintained current knowledge of changes within the healthcare industry related to the prior authorization process.
  • Identified potential problems or discrepancies within the authorization process.

Eligibility, Referral & Authorization Specialist

Innovative Healing Systems
Tampa
08.2015 - 03.2018
  • Assessed insurance benefits and determined eligibility criteria.
  • Communicated with internal teams regarding changes in policy or procedure related to prior authorization process.
  • Identified opportunities for improvement in existing processes and procedures related to prior authorizations.
  • Researched medical policies to ensure appropriate coverage of services.
  • Processed appeals for denials in accordance with established procedures.
  • Responded promptly to inquiries from providers, members, and other departments within the organization.
  • Provided timely feedback to physicians regarding authorization status.
  • Reviewed prior authorization requests for completeness and accuracy.
  • Facilitated communication between health plan representatives, providers, and members when needed.
  • Provided support by answering inquiries related to the authorization process.
  • Maintained current knowledge of changes within the healthcare industry related to the prior authorization process.
  • Identified potential problems or discrepancies within the authorization process.

Education

High School Diploma -

Roberto Community Academy High School
Chicago, IL
06-2005

Skills

  • Claims processing
  • Data entry
  • Authorization management
  • Patient communication
  • Policy compliance
  • Customer service
  • Organization and time management
  • Verbal communication
  • Problem solving
  • Research skills
  • Attention to detail
  • Time management
  • MS office
  • Typing speed is 45 WPM
  • HCPCS
  • Avid learner
  • Payer Portals
  • WayStar
  • CMS Website

Languages

Spanish
Limited

References

References available upon request.

Timeline

Eligibility & Authorization

TGH Imaging Powered by Tower
08.2024 - Current

Medicaid Room & Board Biller

Gulfside Healthcare Services
04.2023 - 08.2024

Insurance Eligibility & Authorization

Florida Pain Management Center
02.2022 - 03.2023

Prior Authorization Specialist

Tower Radiology
03.2018 - 02.2022

Eligibility, Referral & Authorization Specialist

Innovative Healing Systems
08.2015 - 03.2018

High School Diploma -

Roberto Community Academy High School

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Tania Johnson