TANGIE R. JOHNSON

**** ** ******* **. *

Jacksonville, Florida 32210

904-***-****

OBJECTIVE:

To secure a career opportunity which offers the potential for long-term growth and continued challenges.

EDUCATION:

Glynn Academy High School, Brunswick, Georgia, Diploma May 1984

Florida Community College, Office System Specialist, Technical Certificate,

1992-1993, enrolling at Phoenix University next term to obtain my AA in Human Services.

EXPERIENCE:

03/21/2022 – Present Billing Specialist (PB Vertical), Baptist Health, Jacksonville, FL

Ensure each claim is billed out appropriately to commercial insurance companies, third party organizations and/or government payers by processing charges in accordance with insurance and regulatory requirements. Verifies the accuracy and completeness of all charges on claim to ensure that the appropriate charges are in place and to capture any missing or incorrect information. Communicates with various departments to resolve any outstanding issues with claim prior to claim being billed out. Researches and resolves any electronic claim delays within a timely manner, including unreleased and/or rejected claims in the billing system. I have experience in HB and PB

12/15/2021 – 03/20/2022 Revenue Cycle Specialists (Physician Biller), Baptist MD Anderson, Jacksonville, FL

To obtain reimbursement for services rendered by a Baptist MD Anderson Cancer Physician,

as a Physician biller I receive a daily unbilled report to work. As a Physician Biller I am assigned via patient last name ALPHA split working accounts in the SMS (Wilma). As I identify accounts with billing errors that can intel CPT Codes, Diagnosis and Modifiers, I will distribute them to certain data mailers for escalation. Depending on the billing error this could encompass sending the account back to coding, or another department to have the error resolved. I am also responsible for working Relay Assurance claim edits daily. To resolve errors I also work in Cerner to retrieve patient information to update the account in Relay for release and also to bill out the account SMS. I also utilize the HIPPASpace website for look up to locate the Physician NPI number, Provider License Number and Provider Taxonomy code to update the accounts for adjudication.

04/13/2020 – 12/14/2021 Revenue Cycle Specialists (Hospital Biller), Baptist MD Anderson, Jacksonville, FL

Ensures each oncology service related claim is billed out appropriately to commercial insurance companies, third party organizations and/or government payers by processing charges in accordance with insurance and regulatory requirements. Verifies accuracy of charges rendered and coding of same, communicates with coders to ensure appropriate billing edits are resolved (i.e. MUE edits, modifiers, correcting diagnosis). Researches and resolves any electronic claim delays within a timely manner, including unreleased and/or rejected claims in billing system. Possesses up to date knowledge related to CPT codes, ICD/10 codes, NCCI edits, MUE edits and Payer edits.

11/14/2016 – 04/10/2020 Medicare Discrepancy Analysts, HCA/Parallon, Orange Park, FL

I analyze the Medicare work discrepancy report to determine the types of discrepancies and assign appropriate reason codes. I make all corrections of non-payment related discrepancies. I forward all other discrepancies to Overpayment or Underpayments and the Medicare Service center for review. I review the Inpatient UB-04 form from the facilities. I use the Centers for Medicare and Medicaid Services (CMS) Pricers to calculate the Medicare payment from the CMS.gov site. I adjust Contractual on accounts to bring the account to the correct balance. I review the Direct Date entry (DDE System) to analyze the Healthcare Common Procedure Coding (HCPC Code) denial reason to forward the account to the Medicare Service Center (MSC).

05/05/2015-11/13/2016 Overpayment Team Lead, HCA/Parallon, Orange Park, FL

I am responsible for the 304 inventory for Lifepoint, OSG and HCA facilities sorting the work and sending it out to the appropriate analyst and daily check to ensure that the work is adjudicated by the refund date. I report every Tuesday for efficiency accounts to the manager. I review and approve the analyst work in the CRP (credit refund tool) and in Etran. I assist the with the analyst questions concerning calculations and researching the insurance contracts. I work voice mails and faxes from the customer service area by reviewing, recalculating the accounts and making return phone calls as needed. I assist the team with working accounts as needed to obtain our team goals. I trend reports for possible modeling issues. I provide introductory and ongoing training and education to staff to ensure policies and procedures are followed. I meet with the manager regularly to effectively communicate and resolve overpayment issues, set a prioritize goals and improve processes. Assists with staff communication providing updates, resolving issues, setting goals and maintain standards. I maintain established departmental policies and procedures, objectives, patient and customer service policies assist with payroll activities for the team (i.e., time cards, edit sheets). Assist manager with development and implementation of department and project actions plans. Initiate refunds of identified overpayments and monitor take backs as appropriate. Perform validation of discrepancy reason codes assigned by the Discrepancy Analyst.

02/14/08-05/05/2015 Discrepancy Analyst, HCA/Parallon, Orange Park, FL

I analyze accounts that need Iplan changes using specific tools such as Host and Artiva, I correct contractual’s to bring the account to the correct balance, I communicate internally and externally through the DET Tool to adjudicate accounts, I process accounts so that they may be refunded to the patient or the insurance companies. I document accounts clearly and concisely I utilize most of the systems to make sure that the account is adjudicated correctly. Using the Payor Facts system, the CMS Pricer, the Medicaid Calc Tool I calculate accounts, I adjust the account accordingly using the Etran System.

7/9/01-02/14/2008 Refund Analyst, HCA/Parallon, Orange Park, FL

I identify and resolve discrepancies on the accounts such as net benefits, covered days, payments, total charges, refund to patients, refund to primary insurance companies, refund to secondary insurance companies, contractual adjustments and patient payments transfers to open accounts for the patient. Document the accounts and communicate the adjudication of the account and mentor new employee’s on the policy and procedures for the Refunds Department. I have experience in Artiva, Host, Document Direct, Regulus,

DET Tool, Credit Refund Tool, Etran, Onbase power user and the Blue Cross Blue Shield system for online remits for the Vaughn facility.

10/97-7/01 Service Associate II, Blue Cross Blue Shield Jacksonville, FL

Responsible for providing excellent customer service and accurately examining and performing research request inquires. Effectively interpreted contract benefits in accordance with the specific claims processing guidelines. Communicated excellent decision-making skills with all external and internal contracts for PPC plan. Educated customers regarding benefits and services in a responsible, accurate and professional manner. Receiving, organizing and making daily use of information regarding benefits, contract coverage’s and policy decisions. Reviewed and worked 1500 claims, sent letters to the physician office concerning the denial of their submission, received faxes from the physician concerning their 1500 form submission work with medical review nurses to adjudicate the claims.

SKILLS:

Multiple tasks oriented, good communicator and a team player. I have experience in Hospital billing (HB), Physician billing (PB), CPT coding, ICD-10 coding,

Medical Terminology, Ancillary codes and HCPC codes, NCCI edits, MUE edits and Payer edits. Experience in Microsoft Word, Microsoft Windows, Excel (Intermediate), 3M HDM System, SMS (Wilma) and Cerner and EPIC. I am flexible to the needs business. I can work independently and follow directions once given a clear directive.

REFERENCES: Available upon request.

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