TYLISHA JOHNSON

Developed and implemented strategic initiatives to enhance operational efficiency and customer satisfaction.

Led cross-functional teams to streamline delivery processes, reducing turnaround time for shipments.

Established key performance indicators to measure success and drive organizational growth.

Analyzed market trends to identify opportunities for expansion into new service areas and demographics.

Mentored senior leadership team, promoting a culture of innovation and accountability within the organization.

Oversaw budget allocation, ensuring alignment with strategic objectives while maximizing resource utilization.

Achieved company growth by implementing strategic plans and streamlining operations.

Managed partnerships and strategic business relationships by negotiating contract terms and handling conflicts.

Developed key operational initiatives to drive and maintain substantial business growth.

Advocated for sustainable practices, implementing eco-friendly delivery solutions across operations.

Enhanced brand reputation with effective marketing campaigns and public relations efforts.

Fostered partnerships with technology vendors to integrate advanced logistics management systems.

Healthcare billing and collections

Specializing in Medicaid accounts

Generate sales leads/ assist member with open enrollment questions

Identify and assess member’s needs to achieve satisfaction

Proficient in Medicaid/ Medicare billing and regulations

Strong analytical and problem-solving skills

Excellent communication and negotiation abilities

Experience with electronic health record (EHR) systems

Knowledge of healthcare compliance and reimbursement processes/ submit appeals to Medicaid/Medicare Payors

Ability to work collaboratively with cross functional teams

Proficient in Microsoft Excel and billing software

Build sustainable relationships and trust with member’s accounts through open and interactive communication.

Listening to member’s concerns and handling complaints and returns.

Give detailed explanations of services or products.

Review member accounts and transactions while resolving issues.

Review, research, analyze and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing

Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures

Complete data entry for all daily documentation and communicate the status of claims adhering to reporting requirements.

Experience in UB04 reimbursement and pricing

Communicate through correspondence with members and providers regarding claim payment or required information using clear, simple language to ensure understanding.

Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately.

Software Systems Experience:

EMR

Analyzed recovery processes to identify areas for operational improvement.

Collaborated with cross-functional teams to enhance patient engagement strategies.

Oracle Cerner

CPSI

Meditech, eClinicalWorks

NextGen, Allscripts

Greenway Health

EHR

Practice Fusion

Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options according to Program specific SOPs

Verification process could include electronic validation of pharmacy coverage and medical eligibility

Identifies any restrictions and details on how to expedite patient access

Could include documenting and initiating prior authorization process, claims appeals

Completes quality review of work as part of finalizing product

Reports any reimbursement trends/delays to supervisor

Resolved customer inquiries efficiently, enhancing overall satisfaction and loyalty.

Processed claims and managed case files accurately, ensuring compliance with regulations.

Proactively identified and solved complex problems impacting operations management and business direction.

Analyzed denial claims to identify trends and root causes for improved resolution strategies.

Collaborated with billing and coding teams to ensure accuracy in claim submissions and reduce denials.

Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions

Delivered an exceptional level of service to each customer by listening to concerns and answering questions.

Consulted with customers to determine best methods to resolve service and billing issues.

Greeted customers to facilitate services, determine service needs and accurately input orders into electronic systems.

Documented conversations with customers to track requests, problems, and solutions.

Completed documentation for all actions and customer interactions.

Performed full research to check claims and viable solutions to individual issues.

Reviewed accounts with aging balances and contacted customers to review options.

Negotiated dispute resolution and communicated resolution status to customers.

Collects and reviews all patient insurance information needed to complete the benefit verification process.

Verifies patient specific benefits and precisely documents specifics for various payer plans including patient.

Coverage, cost share, and access/provider options according to Program specific SOPs

Verification process could include electronic validation of pharmacy coverage and medical eligibility.

Identifies any restrictions and details on how to expedite patient access.

Could include documenting and initiating prior authorization process, claims appeals.

Completes quality review of work as part of finalizing product.

Reports any reimbursement trends/delays to supervisor.

Reviews denied claims to ensure coding was appropriate and make corrections as needed.

Ensures billing and coding are correct prior to sending appeals or reconsiderations to payers.

Investigate claims with no payer response to ensure claim were received by payer.

Strong understanding of payer websites and appeal process by all payers including commercial and government payers including VA, Tricare, Medicare, Medicaid, and Medicare Advantage plans

Analyzed data to identify trends and improve operational efficiencies.

Developed training materials to enhance team knowledge and performance.

Led team in executing operational strategies to enhance customer service and satisfaction.

Implemented training programs to develop staff competencies and improve performance metrics.

Streamlined inventory management processes, reducing stock discrepancies and improving accuracy.

Analyzed sales trends to inform product placement and promotional strategies, driving revenue growth.

Coordinated cross-functional teams to ensure seamless store operations and execution of company initiatives.

Developed employee engagement activities that fostered a positive work environment and reduced turnover rates.

Managed and motivated employees to be productive and engaged in work.

Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.

Maximized performance by monitoring daily activities and mentoring team members.

Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.

Mentored junior team members for career advancement, fostering a pipeline of future leaders within the organization.

Reduced operational costs through comprehensive process improvement initiatives and resource management.

Increased market share with strategic business development efforts, expanding into untapped markets.