-+Alaina Johnson

**** ********* ******

Pittsburgh, PA 15206

412-***-****

EDUCATION

**/**** ** **/**** United States Navy NAS Fallon Associates

Business Administration,

**/**** ** **/**** United States Navy NAS Miramar Associates Medical

Management

03/2014 to 11/2015 Ashford University

Liberal Arts

EXPERIENCE of Employment

CNG Home Health Care Agency

Medical Liaison

05/2008 to 11//2014

. Performed comprehensive client assessments on an ongoing basis to

ensure continuity of care.

. Ensured timely and accurate communication and documentation is

submitted to the appropriate payer source for continued authorization.

. Elevated patient, family and/or significant other in the return to

optimal physical and mental health through support and education.

. Counseled all staff.

. Encouraged a safe and efficient working environment by adhering to

agency policies and procedures.

. Maintained confidentiality of all agency and patient related

information.

. Protected patient rights as defined in the patient Bill of Rights.

Organized workload to complete responsibilities in an appropriate and

timely manner.

. Performed other duties as assigned by the Supervising Administrator.

CNG Home Health Care Agency

203 Lynnwood Drive, Penn hills, Pa; 15235

Medical Claims Coordinator II

05/2000 to 04/2008

List of responsibilities:

Accounts Payable / Receivable / Medical Billing

. Reviewed a high volume of transactions daily to ensure data is

received and reconciled appropriately.

. Researched and corrected errors, variances and exceptions.

. Communicates with team members and Field Consultants to resolve

reporting problems or out-of-balance conditions.

. Provided guidance to the field in processing corrections to errors.

. Assist Team Leader in monitoring tolerance levels to ensure their

appropriateness.

. Other financial, accounting and treasury duties as necessary.

. Handled first party medical benefit claims, including fatalities for

compensability.

. Evaluates and makes recommendations regarding coverage.

. Conducts investigations, determines total value of claims, sets and

maintains adequate reserves and manages cases.

. Prepares related correspondence and reports, obtains medical and

employment related records, calculates wage loss claims per applicable

state laws, and brings claims to conclusion.

. Remains current on trends and latest developments in the medical

management field. Attends related training programs when required.

. Processing claims with cpt and icd-9

. Assists defense counsel in trial preparation of litigated medical

management claims.

. Assigns, monitors and controls activities of vendors

. Evaluates processes and takes appropriate action on claim-related

bills, medical rehabilitation and special investigative reports.

Determines claims to be paid or contested.

. Request information from Providers.

United States Navy

Material Control

09/1992 to 12/1994

Duties were as follows:

Location: Aboard the USS Kittyhawk, Overview -Men - 4709; Women - 291.

Position: Accounts Payable / Receivable Material Controll/Auditor /Customer

Service Production.

. Duties included, but not limited to the following: with 24 turn-around

timeframe required daily report to CO and XO per Nasvab in a timely

manner.

. Data entry, Format Spread Sheets, Organization, Communication.VFA -

542 Air Line Hanger and or USS Kitty-Hawk or the USS Roosevelt.

. Parts and or equipment need for all Air Crafts and or any and all Air

Craft Carriers. Billing, Raw Materials, Chemicals, Weapon Control.

Skills:

Accounts Payable/Receivable, auditing, inventory, office management,

records management, database administration, case management, charting,

medical supply control spreadsheets, excellent communication skills; oral

and written.

Computer / Office Skills:

Strong working knowledge and experience in the following: MS, Word, MS

Excel, MS PowerPoint, MS Outlook, MS Access, MS Project, MS Publisher,

FileMaker Pro, Word 3, 3.5, 5; NAS Skill, Windows Experience Mediation &

Advocacy Programs.

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