Customer Service Insurance
Resume:
TIFFINY JOHNSON
St. Louis, MO ***** • **.************@*****.*** • 314-***-****
Profile
Energetic and results driven professional with extensive experience in the
medical billing process. Experienced Health Information Professional with
20 years of health care experience. Proven ability to meet time lines for
submission of claims and records processing assignments. Knowledge of
anatomy and physiology, insurance follow up/appeals for plastic surgery,
anesthesia, cardio thoracic, orthopedic, radiology, pediatrics, internal
medicine, and cardiology, patient information systems, word processing,
spreadsheet and database management for the medical billing revenue
cycle. Detailed oriented, organized, strong interpersonal and teamwork
skills.
Education
Parkway South Senior High Diploma 6/1990
Central Missouri State University 8/1990 5/1991
Independent Career Institute Missouri Real Estate License 6/2001
Forest Park Community College Healthcare Information Technology –Present
Experience
Washington University School of Medicine
Insurance Biller Collector II Payment Poster
August 2009 Present
Post HMO/PPO, Medicare, Medicaid, Commercial, Workers Compensation, and Self Pay
payments/contractual adjustments to the patient’s account. Transfer balances to self pay or
secondary insurance for payment. Note appropriate denial codes on accounts before sending to
the follow up/appeals team. Responsible for balancing batches daily resulting in researching
issues and correcting errors. Provides feedback to patients, insurance companies, and
department representatives when needed.
Contributions:
• Consistently meets the established department Quality Assurance standard of 95%.
• Successfully completes projects/duties with positive feedback.
• Assist co workers with technical issues per supervisor request.
• Successfully research complicated insurance payment offsets.
Washington University School of Medicine
Insurance Biller Collector II Follow Up/Appeals
September 2007 July 2009
Performed collection follow up duties for HMO/PPO, ensuring timely and accurate payment of
physician charges for the following areas: Radiology, Pediatrics, and Internal Medicine. Contacted
insurance companies regarding payment delays. Utilized payer’s websites to check claim status.
Investigated and appealed unpaid and/or underpaid claims (Drafted and submitted appeal letters to
insurance companies for denied services.) Submitted requested information to payers as needed.
Posted contractual adjustments to patient’s accounts when needed. Verified and updated patient’s
insurance information. Evaluated customer billings for accuracy and contractual payment. Served as
patient advocate by referring patients and their families to available resources.
Contributions:
● Researched denied claims and submitted the necessary documents needed for payment.
● Worked closely with key personnel at the doctor’s office.
● Provided tenacious follow up to ensure proper payments were fully collected.
● Trained new employees.
KSL Billing Service
Customer Service/Payment Poster
August 2004 May 2007
Posted HMO/PPO, Medicare, Medicaid, Commercial, Workers Compensation, and Self Pay
payments/contractual adjustments to the patient’s account. Transferred balances to self pay or
secondary insurance for payment. Generated HCFA 1500 claims to be submitted to insurance
companies with attachments. Documented appropriate denial codes on accounts before sending to
the follow up/appeals team. Responsible for balancing batches daily resulting in researching issues
and correcting errors. Provides feedback to patients, insurance companies, and department
representatives when needed.
Contributions:
● Delivered consistently on deadlines.
● Worked closely with key personnel at the doctor’s office.
● Entrusted with supervisor duties when needed.
● Assisted other teams with cash posting when needed.
● Responsible for training, correcting and delegating work to department interns.
Parkcrest Surgical/HSI
Insurance Billing Representative
April 2008 June 2004
Performed collection follow up duties ensuring timely and accurate payment of Plastic Surgery and
Orthopedic physician charges. Drafted and submitted appeal letters to insurance companies for denied
services. Established cooperative relationships with key personnel in the doctor’s office, ensuring timely
receipt of documentation needed to appeal denials. Submitted requested information to payers as
needed. Posted payments/contractual adjustments to patient’s accounts. Extensive phone
communications with patients and insurance representatives.
Contributions:
Successfully collected on previously denied claims through persistent follow up; providing insurance
company with necessary documentation needed to reverse initial denials.
Provided tenacious follow up to ensure timely payments.
Medaphis Billing Service
Account Manager
April 1996 August 1998
Managed the entire billing process for two anesthesia practices and a cardio thoracic practice.
Responsibilities included: Charge Entry, Claim Submission, Denial Management, Payment
Posting, Patient Billing, A/R Follow up, and generated end of the month reports.
St. Mary’s Health Center
Medicaid Biller
March 1994 March 1996
Entered and submitted facility charges for Missouri Medicaid patients. Responsibilities included: A/R
follow up/appeals, verified the patient’s eligibility via Point of Service Terminal or calling the
Interactive Voice Response, submitted the Medicare to Medicaid crossover claims, and answered
incoming calls from patients.
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