Medical Management
Resume:
-+Alaina Johnson
Pittsburgh, PA 15206
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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