Taylor Johnson
Baton Rouge,LA
Summary
Detail-oriented healthcare access professional with 15 years of experience in insurance verification, prior authorizations, and claims resolution for commercial and government payers. Expertise includes conducting insurance investigations, performing financial assessments, and processing patient assistance program applications. Proficient in reviewing benefit coverage and resolving reimbursement challenges while ensuring compliance with HIPAA, CMS, and ERISA guidelines.
Overview
1
1
Certification
14
14
years of professional experience
Work History
Patient Assistance Counselor III
AbbVie
09.2025 - Current
- Conduct comprehensive benefit investigations, including insurance verification, medical/pharmacy coverage review, prior authorization, and step-therapy requirements.
- Enroll patients in manufacturer PAP, copay/coupon, bridge, and alternate funding programs per eligibility guidelines.
- Review financial documents and calculate household income to determine program eligibility.
- Educated patients and office staff on program requirements, documentation, and reverification timelines to ensure compliance and understanding.
- Contact patients and HCPs to resolve missing application information.
- Managed complex cases involving denials, appeals, coordination of benefits, and REMS requirements to facilitate patient access to necessary medications.
- Documented interactions in CRM systems per HIPAA and PDMA standards, ensuring accurate identification of adverse events for pharmacovigilance reporting.
Senior Claims Specialist
R1 Revenue Cycle Management
Baton Rouge, LA
07.2022 - 06.2025
- Monitored claim status reports to identify unpaid, denied, or pending claims beyond standard timelines, ensuring timely follow-up.
- Contacted insurance companies via phone, payer portals, or written correspondence to determine claim status and resolve outstanding balances, facilitating timely payments.
- Correct and resubmit denied or rejected claims in a timely manner.
- Prepare and submit appeals for denied claims, including gathering supporting documentation.
- Monitor claim status reports and identify claims that are unpaid, denied, or pending beyond standard timelines.
- Document all follow-up activity, payer communications, and claim resolutions accurately in the claims/billing system.
- Identified trends in denials and escalated recurring issues to management, contributing to improved claims processing strategies.
- Collaborate with billing, coding, and clinical staff to obtain necessary information for claim resolution.
- Stay current on payer policies, timely filing limits, and regulatory requirements (e.g., HIPAA, CMS guidelines).
Patient Access Specialist
Ochsner Health
Baton Rouge, LA
09.2017 - 04.2022
- Confirm insurance eligibility and benefits; obtain and document prior authorizations or referrals as required.
- Verified insurance eligibility and benefits; secured and recorded prior authorizations or referrals.
- Collected co-pays, deductibles, and outstanding balances at time of service; clarified financial obligations and payment options for patients.
- Coordinate with clinical staff, financial counselors, and case management to resolve registration or coverage issues.
- Coordinated with clinical staff, financial counselors, and case management to resolve registration and coverage issues, ensuring seamless patient access.
- Respond to patient inquiries regarding billing, scheduling, and general hospital services, or direct them to the appropriate resource.
- Identify and correct registration errors to minimize claim denials and billing delays.
- Obtain necessary signatures on consent forms, HIPAA acknowledgments, and other required documentation.
- Identified and corrected registration errors, reducing claim denials and expediting billing processes.
Prior Authorization Specialist
Cohere Health
Baton Rouge, LA
02.2013 - 09.2017
- Review incoming prior authorization requests for completeness, accuracy, and required clinical documentation.
- Enter and process requests within Cohere's proprietary platform, following payer-specific and clinical guidelines.
- Respond to inbound calls from providers and their staff regarding authorization status, documentation requirements, and next steps, while maintaining call quality and service-level standards.
- Communicated with providers, health plans, and internal clinical teams to resolve missing information and discrepancies, reducing delays in authorization processing.
- Tracked authorization status and turnaround times, escalating at-risk cases to ensure timely resolutions.
- Identified patterns in denials and documentation gaps, flagging them for process improvements and training initiatives.
- Maintain accurate records within Cohere's systems in compliance with HIPAA and payer regulatory requirements.
- Collaborate with clinical reviewers, quality teams, and account management to support a smooth end-to-end authorization experience.
Education
High School Diploma -
Belaire High School
Skills
- Patient access
- Pre-authorization
- Eligibility verification
- Benefits verification
- Claims management
- Claims adjudication
- Claim denial resolution
- Reimbursement analysis
- HIPAA
- Medicare/Medicaid compliance
- Provider communication
- Customer service
- Client interaction management
- Patient assistance program support
Certification
- Microsoft Office Specialist (MOS)
- Medical Reimbursement Specialist
- HIPAA Privacy and Security Certification
- Revenue Cycle Representative (CRCR) - HFMA
Timeline
Patient Assistance Counselor III
AbbVie
09.2025 - Current
Senior Claims Specialist
R1 Revenue Cycle Management
07.2022 - 06.2025
Patient Access Specialist
Ochsner Health
09.2017 - 04.2022
Prior Authorization Specialist
Cohere Health
02.2013 - 09.2017
High School Diploma -
Belaire High School