Tiana Johnson
Goodyear,AZ
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
7
7
years of professional experience
Work History
Data Resolutions Specialist
TriWest Healthcare Alliance
Phoenix, AZ
02.2019 - Current
- Reviewed customer claims, identified discrepancies and determined appropriate course of action.
- Verified documents to ensure accuracy of information provided by customers.
- Maintained accurate records of all claim activities in accordance with company policies.
- Evaluated provider qualifications, including education, training, experience, licensure, certification and other criteria.
- Researched discrepancies in data submitted by providers or obtained from external sources.
- Utilized advanced analytics tools such as SAS, SPSS, Excel PowerPivot, to manipulate large volumes of structured and unstructured data sets.
- Collaborated with other departments to obtain additional information needed for claim resolution.
- Initiated contact with customers by phone, fax and e-mail concerning claim status updates.
Pharmacy Customer Service Representative
McKesson
Tempe, AZ
07.2017 - 01.2019
- Validated patient insurance coverage and verified eligibility for prescription medications.
- Assisted in accurate and efficient prescription filling alongside pharmacists.
- Resolved customer complaints and concerns in a professional manner.
- Maintained strict compliance with HIPAA regulations to ensure patient privacy and confidentiality.
- Responded to incoming calls promptly, courteously and professionally.
- Documented and maintained accurate records of customer interactions and transactions.
Education
Cosmetology License - Cosmetology
Empire Beauty School - Glendale
Glendale, AZ12-2017
Skills
- MS Office
- Remote Office Availability
- Quality Assurance
- Customer Service
- Claims Processing
- Claims review
- File and Record Management
References
References available upon request.
Timeline
Data Resolutions Specialist
TriWest Healthcare Alliance
02.2019 - Current
Pharmacy Customer Service Representative
McKesson
07.2017 - 01.2019
Cosmetology License - Cosmetology
Empire Beauty School - Glendale
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