Daytha Johnson

530-***-****

PROFESSIONAL SUMMARY:

• 2+ years of experience working in administrative positions performing various faxing, mailing, and customer service duties

• experience working in the healthcare field entering data into systems and filing claims

• Worked in a fast-paced call center environment answering inbound calls from customers and logging calls

POSITION SUMMARY:

UnitedHealth Care/Group/Optum 360:

Clinical Administrative Coordinator: 02/2022 to Present

2+ years of of experience working with ICD-9 / 10 and CPT codes Experience working with Microsoft Word (creating, editing, saving documents) and Microsoft Excel (creating, editing, saving spreadsheets)

Experience working with a PC and windows applications, with the ability to learn other sometimes complex systems/MS Chat

Any experience working within the healthcare industry

Working knowledge of medical terminology

Required to have a dedicated work area established that is separated from other living areas and provides information privacy

Ability to keep all company sensitive documents secure (if applicable)

NLT (National Letter Team): Following strict company Guidelines: setting up letters to be sent out to Member's, Provider's, and other facilities for denials of treatment

toggle though 3(three) computers

research when needed

continuous contact with team leads, and supervisor

very close attention for detail

continuous training

100% Remote

Cor-Tech: (CVS Healthcare): Work from Home: 04/2021 to 10/2021

Specialty Prior Auth agent

●Customer service (Call Center)

●Self-Management/ Self Organized

●Ability to toggle between computer system’s

●Research information while on Inbound calls/ and Outbound calls

●Knowledge with Medical terminology/ ICD codes

●Virtual meetings/ Toggle between screens

●Specialty Medication Intake agent:

●Electronic Faxing medical information

●Documentation review/ Medical chart notes

●Strong communication skills with (ALL) medical staff/ dispensing Pharmacies

●Prior Authorization for Specialty medications

●Aetna/CVS Caremark:

●Overrides/ Medical math on dosage

●Verification of NPI’s,

High attention to Privacy/ HIPPA Self-Management:

Deloitte-Fortuna BMC-Work from Home Position: 01/2021-05/2021

●Customer Service, assistant line

●Must be organized, Computer savvy.

●Able to always deal with Escalated situations.

●Self-Management, Time Management, Fast learner,

●Knowledge, and confident with speaking with others

●Able to research for information.

●Multi-task, able to toggle through Computer systems, Multiple Screens.

●Working from Hardline, or through Wifi

●EDD (Employment Development Dept), New York State Vaccine Hotline

●Keeping track with adherence

●Answering at least 50 or more calls a day.

●Use to sitting for long periods of time,

●Very good with working in close off, quiet areas

Travis Credit Union, Vacaville, Ca ( on-site)

Call Center Teller: 06/2019 – 01/2020

●Receives phone calls in a Call Center environment with an emphasis on performing a variety of basic transactional and member support services in an efficient and professional manner.

●Recognizes the value of member retention and uses sales skills to provide general information about all products and services and cross-sells when applicable.

●Evaluates the member relationship for the possibility of activating new products and services.

●Understands the importance of, and works towards, achieving the credit union’s short- and long-term strategic plans.

●Understands the importance of schedule adherence and the role it plays in maintaining the Call Center’s service objectives.

●Able to manage escalated calls without assistant’s

●Researching accounts/ and knowledge on services

Walgreens, Vallejo, Ca October 2018 to 03/2019

Shift Lead: Obtains and maintains valid PTCB certification or pharmacy license as required by the state.

●Complete product returns, order voids, customer refunds, cash drops to the safe, and provides change as requested to cash registers.

●Maintain positive working relationships with direct reports, peers, vendors, union officials, and corporate office personnel.

●Open and close of store, / (Work in a 24-hour store)

●Prioritize, plan and coordinate work activities for the entire staff using effective time management skills.

●Manage and track store financial performance, inventory safety, customer service and management of entire staff.

Faneuil (Covered California) Sacramento, California November 2017 to March 2018 Customer Service/Administrative Assistant

• Served customers by determining requirements; answering inquiries; resolving problems; fulfilling requests; maintaining database

• Determined requirements by working with customers and answering inquiries by clarifying desired information

• Researched, located, and provided information

• Resolved problems by clarifying issues, researching, and exploring answers and alternative solutions

• Implemented solutions and escalated unresolved problems

• Fulfilled requests by clarifying desired information and forwarded requests if needed

Xerox, Sacramento, California October 2014 to February 2015 Customer service Specialist/Administrative Support (Temporary Position)

• Used a computerized system and responded to customer inquiries in a call center environment

• Responded to telephone inquiries and complaints using standard scripts, and procedures, gathering information, research/resolves inquiries and logs customer calls

• Communicated appropriate options for resolutions in a timely manner

• Informed customers about the services available and assessed customer needs,

• Knowledge of Medi-cal, took calls on the provider line of service

Walmart store, Richmond, Ca: February 2014 to May 2014 Customer Service Pharmacy

• Completed work assignments and priorities in Health and Wellness pharmacy facilities

• Ensured fulfillment of pharmacy prescriptions, maintained, and tracked medication inventory

• Maintained automated medication counting machines, processed insurance rejection claims

• Explained medications, knowledge of generic to brand name forms of medications

• Heavy computer software knowledge

Blue Shield of California, San Francisco, California August 2013 to January 2014 Pharmacy Call Center Consultant (Temporary)

• Provided efficient and accurate responses to external customers (physician, office staff, pharmacy providers, members, and brokers) and internal team members

• Resolved outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems

• Communicated drug formulary guidelines including drug formulary alternatives, prior authorization criteria and group/member eligibility problems

• Researched and solved administrative review and consumer affairs issues

Safeway, Novato, California October 2012 to March 2013 Pharmacy Clerk

• Provided superior customer service, set up fills, and maintained pharmacy display cases

• Keen knowledge of working with Medicare and knowledge of waiting for prior authorizations on medications

• Faxed doctors for refills, e-scripts faxing to doctors, medication self pulls, out dates checking, put up order when it came in, fill new prescriptions,

• Heavy phone calls throughout the day working alongside the pharmacist answering questions from patients

Pelsten Group, Martinez, California June 2012 to November 2012 Medical Records Representative/Administrative Assistant (Temporary Position)

• Position held at Contra Costa regional medical building

• Converted medical information from old (ems) electronic medical records system, onto new EPIC system

• Knowledge of computers and medical terminology

• Transcribed doctor's notes from charts, very high in knowledge of medications and data entry

Deer Park Pharmacy, Napa, California September 2010 to March 2011 Pharmacy Clerk (Temporary Position)

• Heavy phone lines, under supervision of the pharmacist

• On the phones with different insurance companies

• Computer knowledge of how to adjust patient profiles for medicine, and label making, customer service, filling prescriptions, taking in new prescriptions, inventory plus, ordering of medicine every day, stocking of medicine and otc's

Kaiser Permanente, San Rafael, California October 2004 to July 2009 Outpatient/Inpatient Pharmacy Technician

• Under supervision and control of a licensed pharmacist, provided in-person, and telephone reception

• Submitted required reports, mixed medicine, ordered medicine for stock and for patients

• Working knowledge of aseptic technique, prepare sterile IV products, knowledge of drug dosage forms, strengths, knowledge of generic and trade names

• Proficiency in the pharmacy computer system, read, understand, and transcribe pharmaceutical information, learning chemotherapeutic agents transcribe, abbreviated, and symbolized information from physician's order into patient medication profile

EDUCATION:

Silicon Valley College, Walnut Creek, California- Vocational School

AAPC Online Classes- Self paced: Medical billing and coding: 06/2022

Certification (Pending Until finished)

Skills:

• Knowledge of claim forms CMS-1500, UB-04, TAR forms- 50-1, using Medi-cal website, overview, completion of forms, checking claim status, appeals, Calpos for pharmacy, and CIF (Claims Inquiry forms) ordering of forms, Check write, help billing agents calling in to get help with, and needing information

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