Yashica Johnson
Tampa,FL
Summary
Results-oriented professional in appeals analysis field. Proven ability to thoroughly review and resolve complex cases with high accuracy, ensuring compliance and customer satisfaction. Known for strong collaboration and adaptability, consistently meeting team goals and adapting to changing requirements. Key strengths include analytical problem-solving and effective communication.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Grievance and Appeals Analyst
Patient Care Management
05.2018 - Current
- Submitted and tracked grievance cases and appeals related to NSA balance billing disputes in compliance with federal guidelines.
- Utilized CMS tools and Independent Dispute Resolution (IDR) platforms to process and report claims data.
- Interfaced with insurance carriers and patients to resolved complex billing and appeals.
- Maintained up-to-date provider rosters, credentialing files, and enrollment status through CAQH and PECOS system.
- Supported accurate and timely electronic submission of clean claims and appeals documentation.
- Used Zendesk to track, manage, and communicate case resolutions efficiently.
- Analyzed denied or unpaid claims to determine root causes and recommended next steps based on payer policies.
- Compiled appeal packets by gathering medical records, physician letters, and supporting evidence to justify claim payment.
- Tracked appeal outcomes, ensured all deadlines were met, and maintained claim status updates in internal system.
- Collaborated closely with healthcare providers and internal departments to obtain documentation supporting successful appeals.
- Managed approximately 30 cases daily.
Medical Billing Specialist II
Stymco Technologies
11.2015 - 08.2017
- Managed the entire billing lifecycle for medical claims, ensuring accurate and timely reimbursement for services provided.
- Resolved pending, rejected, and denied claims through comprehensive analysis and effective communication with insurance providers.
- Collaborated with medical professionals and insurance companies to address claim disputes and expedite claims processing.
- Led payment posting activities from multiple payers, minimizing discrepancies and ensuring precise financial records.
- Effectively communicated with patients, addressing inquiries related to bills, outstanding balances, and coordinating payment plans.
- Identified billing errors, implemented corrective actions, and managed accounts receivable follow-up to minimize financial discrepancies.
- Served as a liaison between internal and external partners, fostering strong relationships to swiftly resolve billing issues and claims disputes.
- Analyzed trends and issues in revenue cycle management, initiating proactive measures to enhance operational efficiency and financial performance.
- Provided valuable feedback and suggestions for improvements in products, technologies, and services, contributing to ongoing process enhancements.
Education
High school diploma -
Armwood High School
Tampa, FL05.2000
Skills
- Grievances & Appeals (NSA Compliance)
CMS Reporting & Independent Dispute Resolution
Credentialing & Re-Credentialing (NCQACAQH Standards)
Provider Enrollment & Primary Source Verification
QNXT Facets Xcelys MD Staff
Salesforce Zendesk PECOS CAQH Availity
Leadership & Staff Training Provider Data Integrity
Electronic Health Records (EHRNextGenEpic)
HIPAA Compliance Audit Support
Microsoft Office Suite
- NextGen Trizetto Brightree Smart Docs Rivet Spot
Medical Coding, Billing & Insurance Procedures
Claims Investigation & Resolution
Medical Documentation & Claims Resubmission
Analytical Thinking & Physical Solving Skills
Certification
- No Surprises Act (NSA) Dispute Handling (2023)
- HIPAA & CMS Compliance Awareness
Timeline
Grievance and Appeals Analyst
Patient Care Management
05.2018 - Current
Medical Billing Specialist II
Stymco Technologies
11.2015 - 08.2017
High school diploma -
Armwood High School
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