Victoria Johnson
Hazlet,NJ
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
11
11
years of professional experience
Work History
Prior Authorization Representative
Cigna-Evernorth Services Inc.
06.2022 - 10.2023
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Verified eligibility and compliance with authorization requirements for service providers.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Processed new medication and refill requests for authorization.
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for medication prior authorization.
- Contributed to departmental success by consistently meeting or exceeding performance metrics such as accuracy, productivity, and quality standards.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Facilitated better communication between departments through proactive engagement with other teams involved in the prior authorization process.
- Supported continuous improvement initiatives by actively participating in meetings, providing feedback, and suggesting areas for improvement.
- Demonstrated adaptability by managing multiple priorities simultaneously, ensuring all tasks were completed accurately and on time.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
Lead Medical Receptionist
Hackensack Meridian Health
01.2014 - 06.2022
- Fielded concerns surrounding patients and care, liaising between physician, patient, and insurance company.
- Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for important details.
- Used computer programs and registration systems to schedule patients for routine and complex procedures.
- Offered ample support to team members with creative solutions to complex challenges regarding scheduling, conflict resolution, and medical care.
- Remained aware of provider schedules and scope of practice on evolving basis to organize and schedule appropriate care.
- Referred and screened patients to make best use of resources, triage staff, and serve community members.
- Increased patient satisfaction by promptly resolving any concerns or issues related to appointments or billing matters.
- Coordinated referrals for specialist consultations, obtaining authorization from insurance carriers when necessary.
- Participated in ongoing professional development opportunities relevant to the role of Lead Medical Receptionist.
- Managed high call volume efficiently, directing callers to appropriate departments or personnel as needed.
- Contributed to a positive work environment by fostering strong relationships with colleagues and displaying excellent teamwork skills.
- Improved overall office organization by implementing a comprehensive filing system for patient records.
- Prepared examination rooms for incoming patients, ensuring cleanliness and availability of necessary supplies.
- Provided exceptional customer service to patients, addressing their needs promptly and professionally while demonstrating empathy and understanding.
- Supported medical staff through diligent record-keeping of lab results, diagnostic reports, and other vital documentation.
- Enhanced patient experience by streamlining check-in processes and maintaining accurate records.
- Streamlined front desk operations by implementing an organized system for handling forms, mailings, and other administrative tasks.
- Maintained clear communication lines between patients, providers, and insurance companies to address any billing discrepancies or concerns.
- Displayed flexibility in accommodating last-minute schedule changes while maintaining orderliness within the practice.
- Effectively communicated appointment reminders to patients through phone calls or email notifications, contributing to a decrease in noshows.
- Ensured compliance with HIPAA regulations, safeguarding confidential patient information at all times.
- Reduced wait times for appointments through efficient scheduling and coordination with medical staff.
- Checked patient insurance, demographic, and health history to keep information current.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Helped patients complete necessary medical forms and documentation.
- Managed multi-line phone system and pleasantly greeted patients.
- Managed master calendar and scheduled appointments for providers based on optimal patient loads and clinician availability.
Cashier and Stock
Multiple Retail Jobs
07.2012 - 01.2014
- Greeted customers entering store and responded promptly to customer needs.
- Welcomed customers and helped determine their needs.
- Worked flexible schedule and extra shifts to meet business needs.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Restocked and organized merchandise in front lanes.
- Stocked, tagged and displayed merchandise as required.
- Unloaded, sorted and stocked merchandise according to store layout and product placement.
- Placed products in correct storage locations to keep stock areas organized and inventory counts accurate.
- Performed inventory control, such as counting, and stocking merchandise.
- Rotated stock correctly to prevent out-of-date products and removed aging items from main shelving to build special promotional displays.
Education
High School Diploma -
Raritan High School
Hazlet, NJSkills
- Basic medical terminology
- Authorizations
- Benefit Coverage
- HIPAA Compliance
- Insurance Verification
- Data Entry
- EMR / EHR
- Adaptable and Flexible
- Patient Referrals
- Customer Service
- Office Administration
- Documentation and Recordkeeping
Computer Software
- ESD
- CSP
- C360
- OnePA
- Citrix
- Verint
- WFO
- KIM and KnowledgeXchange search engines
- GE Centricity EMR
- EPIC EMR
- Microsoft Word and Outlook
Timeline
Prior Authorization Representative
Cigna-Evernorth Services Inc.
06.2022 - 10.2023
Lead Medical Receptionist
Hackensack Meridian Health
01.2014 - 06.2022
Cashier and Stock
Multiple Retail Jobs
07.2012 - 01.2014
High School Diploma -
Raritan High School
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