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
Similar Profiles
Poornima ManiPoornima Mani
Claims Representative at Cigna-Evernorth Services Inc.Claims Representative at Cigna-Evernorth Services Inc.
Allison GlackinAllison Glackin
Plan Implementation Lead Analyst at Evernorth Health Services (The Cigna Group)Plan Implementation Lead Analyst at Evernorth Health Services (The Cigna Group)
Allyson CunninghamAllyson Cunningham
Case Management Lead Representative at Cigna (Evernorth Behavioral Health)Case Management Lead Representative at Cigna (Evernorth Behavioral Health)