Customer Service Medical

JOELLE K. JOHNSON

**** *. ********* ***., *****, TX 75702 ■ Phone: 903-***-**** ■ Email: **********@*****.***

CAREER PROFILE & HIGHLIGHTS

Quality-focused professional with remarkable leadership talents, superb customer service skills and ability to gather and interpret data, seeking professional opportunities with a healthcare organization.

Expertly Manages All Administrative Duties with Ease

Meets All Standards for State & Federal Health Regulations

Outstanding Communicator of Pertinent Information

Demonstrates Impeccable Attention to Detail

Effectively Manages Data & Confidential Records

Performs at High Levels of Accuracy & Productivity

EDUCATION & PROFESSIONAL DEVELOPMENT

Ultimate Medical Academy – Tampa, FL, Medical Billing and Coding Diploma, 2012

DeVry University – Tyler, TX, Associate Degree in Accounting, 2011

CERTIFICATION

Pursuing CPC-A Certification

CORE MEDICAL QUALIFICATIONS

Medical Billing

ICD-9-CM, HCPCS, CPT

Insurance Verification

Anatomy & Physiology

Medicare, Medicaid, TRICARE, Marketplace

CMS 1500, CM 1450 (UB-04), EOB’s

Managed Care (HMO, PPO, and POS)

Insurance Claim Processing

Medical Coding

Intermediate ICD-10-CM

Co-Payments & Deductibles

HIPAA Compliance

MS Office (Excel, Word, PowerPoint)

Electronic Medical Records

Medisoft Software

Insurance Billing Procedures

Electronic Payment Posting

Appointment Scheduling

Medical Terminology

Government Payers

Third –Party Payers

Worker’s Compensation

Office Management

Medical Office Procedures

PROFESSIONAL EXPERIENCE

CENTENE CORP - Tyler, TX

2013- Present

ADVANCED CLAIMS ANALYST

Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied.

Process claims that are related to physician and hospital services, coordination of benefits, high dollar, special pricing, refunds and/ or adjustments on resubmitted claims.

Research and determine status of medical related claims.

Review charges, access the computer system and use payment or denial codes within established department guidelines and standards.

Maintain records, files, and documentation as aappropriate.

Meet production and quality standards.

SOUTHSIDE BANK – Tyler, TX 2008 – 2013

DATA ENTRY SPECIALIST

Entered customers’ data into a computer, operate a variety of office machines, and perform other administrative duties.

Prepared and sorted source documents, and identified and interpreted data to be entered.

Contacted bank tellers to resolve questions, inconsistencies or missing data, if needed.

Scan customers’ information into the computer system.

JC PENNY – Tyler, TX 2007 – 2008

SALES REPRESENTATIVE

Provided exceptional customer service and individualized sales.

Processed and replenished merchandise and monitored floor stock

Addressed client’s questions and concerns.

Received either cash or debit cards from customers to pay for merchandise.

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