Johnna B. Raymond

* ******** **, ***********, ** 08046 609-***-**** add097@r.postjobfree.com

CAREER SUMMARY

Medical Claims Analyst with 13+ years of experience.

Skilled at processing Medicare Advantage Facility and Professional claims, Personal Choice 65 claims

and Region 19 CIS Edits.

Proficient in software applications: OSCAR, MHS, PLANMATE, and CIS.

Licensed Practical Nurse in PA.

Critical thinker, professional demeanor and excellent communication skills.

Adheres to HIPAA regulations to ensure patient privacy.

Knowledge of Medical Terminology.

PROFESSIONAL EXPERIENCE

Processed, researched and corrected Medicare, PC 65 and Personal Choice claims.

Processed pharmaceutical claims.

Processed custodial claims.

Coordinated claims work flow with other departments to meet aged inventory deadlines; met monthly

required claims goals.

Completed daily reports for supervisor.

Provided side by side training for Medicare processing and CIS Edits.

Attended mandatory healthcare seminars focused on updates to healthcare cost and coverage changes to

the member.

EMPLOYMENT HISTORY

AmeriHealth-Caritas, Philadelphia, PA 05/2015 08/2017

Medicare Claims Examiner

Independence Blue Cross, Philadelphia, PA 01/1999 06/2012

Claims Analyst

CERTIFICATIONS AND QUALIFICATIONS

Commonwealth of Pennsylvania Issued: 11/2013

Licensed Practical Nurse

EDUCATION

Prism Career Institute, Cherry Hill, NJ

Licensed Practical Nursing

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