Tyisha Johnson
Sr. Medical Claims Analyst
Greensboro,NC
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.
Overview
9
9
years of professional experience
4
4
years of post-secondary education
Work History
Sr. Claims Analyst
Aspirion Health Resources
Greensboro, NC
2022.11 - Current
- Review and analyze claims to find root cause of claims with adverse financial outcomes to ensure resolution
- Handle difficult claim, patient, and third party follow-up problems
- Establish network of working relationships with individuals at insurance companies
- Proactively identify and manage trends, issues, and maintain written documentation of findings
- Performs analysis of accounts to determine necessary action for resolution of account
- Contacts payers to obtain payment or status to resolve accounts while maintaining good payer relations
- Managed large volume of medical claims on daily basis.
- Responded to correspondence from insurance companies.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Checked documentation for accuracy and validity on updated systems.
Claims Processing Specialist
Aetna, CVS Health Company
Greensboro, NC
12.2020 - 04.2021
- Processing claims accurately to enhance customer satisfaction and retention while also maintaining quality and production standards
- Reviewed claims information to determine the nature of the member’s illness or injury
- Determining and understanding the coverage provided under the member’s health plan
- Efficiently used multiple systems and screens to obtain and record claim information
- Made claim payment decisions
Customer Care Professional
BlueCross and BlueShield of North Carolina, SpectraForce
Greensboro, NC
05.2020 - 11.2020
- Assisted members with Benefits and Claims questions
- Researched claims to ensure proper payment and routing to the appropriate department if claims need to be adjusted
- Provided members with complete and accurate benefits
- Acted as a service relationship management professional for customers, employer group members, and healthcare providers to successfully service health insurance needs
- Assisted students and parents with enrolling or waiving out of Student Blue coverage.
Coding New Business Associate
Lincoln Financial Group
Greensboro, NC
04.2019 - 04.2020
- Input applications into the system for proposed insureds applying for Term, Universal, and Variable Life
- Insurance
- Reviewed submitted documents to ensure that all paperwork and required forms are in good order
- Handling rush New Business applications in a timely manner
- Prioritizing requests to ensure that Service Level Agreements are met
- Made sure all data entered is accurate
- Carries out duties in compliance with all state and federal regulations and guidelines
- Complied with all company and site policies and procedures
- Made a positive contribution as demonstrated by making suggestions for improvement and learning new skills, procedures and processes
- At Home iOS/Mac+ Advisor Chat Support
At Home IOS/Mac+ Advisor Chat Support
Apple Inc
Roanoke Rapids, NC
05.2015 - 04.2018
- Handling 1-3 chats at a time to help customers with their iOS, Apple Watch, Beats, and Mac while maintaining a good relationship between Apple and our customers
- Adapting to different communication styles and finding the best way to explain things to the customers
- Providing information that customers may not have known that their device could do
- Mentored team members who were having trouble with chats
- Acted as Subject Matter Expert with our Knowledge-base and helped co-workers find the information they needed for chats
- Created PDF step-by-step guides on the employee media platform to help with complicated and frequent chat /call drivers
- Set up a video conference (with TM approval) room so that anyone who needed assistance with a difficult chat that others could join to seek help from their co-workers
- Stayed up to date with any issues that may cause customers to contact us to notice any trends and stay ahead of issues
- Always shared this information with co-workers
- Constantly tried to improve and be innovative to make sure customers were given the best experience
- Customer Care Professional/New Hire Mentor
Customer Care Professional/New Hire Mentor
Sykes at Home
Roanoke Rapids, NC
07.2014 - 04.2015
- Answered customer requests or inquiries concerning services, products, billing, equipment, claims and reports problem areas
- Improved customer retention through programs and services provided to the customer
- Utilizes mechanized systems to initiate and complete service orders and handle customer requests
- Performed technical troubleshooting; upgraded equipment; researched disputes
- Make recommendations according to customers' needs on features, accessories, upgrades, and rate plans also educating customers on new services and promotions
- Utilize operational systems to process purchases of AT&T products and services
- Payments for Wireless bills and accessories
- Provided mentor support chat in a leadership role for agents in nesting.
Rapid Resolution Expert/Claims Reprocessing Expert
UnitedHealth Group
Greensboro, NC
01.2007 - 02.2010
- Adjusted medical, vision, and dental claims that were processed incorrectly
- Replied to basic customer service inquiries regarding benefits, eligibility, member materials, providers, authorization, and explanations of benefits
- Took inbound calls and de-escalated calls
- Placed outbound calls to providers to resolve billing issues
- Worked closely with other departments such as Appeals and Pre-Authorization to resolve member issues
- Extensive research into benefits and Standard operating procedures experience in order to ensure proper payment of medical claims
- Used knowledge of EOB's of other insurances and Medicare to ensure proper payment
- Delighted customers with rapid resolution and initial ownership of issues
- Handled repeat callers, escalated issues, and highly complex customer inquiries
- Thoroughly researched all open inquiries based on established thresholds and followed up as needed to resolve issues
- Maintained 100 percent claim processing accuracy
- Maintained at least 99 percent quality assurance performance.
Education
Inpatient And Outpatient Medical Coding & Billing -
09.2022 - Current
High school diploma or GED -
09.1996 - 05.2000
Skills
Chat Support
IOS Technical Support Experience
Insurance VerificationDocumentation reviewICD-10 and ICD-9
EMR systemsOrganizational and Communication
Clerical ExperienceHIPAAWord processingScheduling
Data entry: Attention to detail
Maintaining data integrity by detecting errorsMicrosoft Office (Word, Excel, Access, PowerPoint), Internet Explorer and severalAdept at creating macros and other shortcuts to improve efficiency65 WPM Typing Speed
Claims review
Transactions reconciliation
Insurance coverage verification
Data integrity