Candy Johnson Email & Phone Number

Johnson City, TN, US

Murray, Utah, US

• Generate, review, refine, and facilitate execution of complex client contracts.
• Ensure that contracts meet all compliance regulations, internal policies, and technical requirements.
• Manage the contract lifecycle from new contract requests, contract approvals, contract maintenance, and contract termination.
• Maintain contractual records and documentation for all clients and projects for accuracy.
• Establish and maintain strong business relationships with internal and external stakeholders to effectively manage contract inquires, issues, and disputes.
• Analyze significant and/or unique contract requirements, assist with processing contract redlines, implement, develop and identify new contract policy and processes.

Powell, Ohio, US

• Perform full audit cycle, evaluate internal controls including corporate governance processes, risk management and control management over operations' effectiveness.
• High accuracy rate and compliance with applicable legal requirements and policy and procedures serving as the foundation of the SOC 1&2 controls and compliance.
• Review client workbooks for accuracy against statement of work, collect, analyze and summarize information.
• Adaptability and proficiency in internal leading industry software, support ongoing process and system development especially in times of evolving government program changes.
• Stay current on industry trends as it relates to Class of Trade assignments as well as with managed care and pharmacy benefit managers.
• Collaborate with and support team members, contribute to a positive working environment by building solid relationships.

Northbrook, IL, US

• Problem solving and analysis related to loss and expense management in the total loss department.
• Review documentation to comply with internal quality and process standards as well as adhere to each state assigned processes.
• Manage sales support staff, provide direction, support, motivation and prepare for state licensing exams.
• Processed weekly payroll, managed incoming payments and oversaw daily deposits.
• Responsible for resolving problems, identifying and analyzing trends, ensuring customer retention.
• Personalized sales and service for book of business and new clients for auto, home, life and health insurance.

Northbrook, IL, US

Northbrook, IL, US

US

• Managed the admission/discharge information post-notification working with hospitals and clinical teams.
• Managed requests for services providing information on available network services, manage the referrals process and census roles.
• Plan, prioritize, organize and complete established objectives. Extract data to better help members receive medical or clinical services.
• Reviewed all member charts prior to a physician appointment and create alerts/trigger to highlight STARS opportunities for the provider.
• Assisted members in navigating their network of Providers by assisting with follow-up and Specialist appointments as needed.
• Assisted with Program Eligibility verifications.

• Responsible for assisting in development and implementing education, training and learning needs for end-users of various Information Systems initiatives
• Assisted in the planned redesign of work flow & processes to optimize development of education and training in the clinical system capabilities to achieve critical objectives for improved patient safety and care.
• Participated in the education and training related to the Mountain States Health Alliance information systems applications to ensure education and training represented best-practice, evidence-based, patient centered.
• Worked collaboratively with clinicians serving on application project teams, and accountable for assisting with development and implementation of education and training in synch with project timelines
• Worked collaboratively with other project members while actively participating in day-to-day planning and operations. Duties included monitoring project work plans that focus on clinical education and training content.
• Participated in the development, education, training and implementation of the super user and core trainer roles for unit-specific support and for new application roll-out education and training.

• Managed the medical audits requested by Recovery Audit Contractors (RAC), CMS, Medicaid, and other third party payers for the MSHA hospital facilities
• Oversaw and implemented the auditing process
• Ensured medical records and appeal documentation was submitted within the required timeframes
• Established to meet Corporate objectives
• Responsible for logging all accounts
• Requested for audit by RAC and/or CMS into the Revenue Integrity Compass system and following those accounts through the audit process

• Assisted in the developing and implementing the education, training and learning needs for end-users of various Information Systems initiatives
• Responsible completion of practitioner applications and locums for participation in managed care plans
• Completed and Maintained Practitioner Re-Credentialing Applications
• Adhered to NCQA standards, Maintained strict confidentiality
• Worked closely with the Central Billing Office (CBO) to resolve any problems that might affect payment of claims
• Worked closely with office managers in order to obtain practitioner signatures and specific information necessary

• Responsible for assisting in the developing and implementing the education, training and learning needs for end-users of various Information Systems initiatives
• Oversaw the Refunds Department for MSMG physician offices and MSHA Hospital facilities
• Processed Insurance & Patient refunds for MSMG Physicians Sites and 14 Hospitals
• Posted patient and insurance payments
• Provided information to implement Refund Process throughout MSMG Physician Offices to staff.
• Responsible for TennCare/Medicaid Physician & Hospital accounts, handling eobs, pending reports, secondary claims, e-mails, phone calls

Johnson City, TN, US

• Responsible to the Clinical Director for the day-to-day business management of the Student Health Clinic at East Tennessee State University
• Supervised office staff and student workers
• Coordinated with providers and nursing staff to ensure efficient clinic operations
• Coordinated office staff scheduling
• Participated in the development of and maintaining updates and implementing policies and procedures as well as a new database that was used campus wide (Banner)
• Ensured that end-of day functions were completed by office staff

• Communicated with the major third-party payers including Medicare and Medicaid along with Blue Cross/Blue Shield, John Deere, Cigna and other large insurance companies.
• Processed billable medical charges, patient billing and collections using the Medisoft medical software program
• Performed insurance follow-up and denial management
• Oversaw office audits with Wellmont Health Systems and received a 100 % rating
• Maintained Physician’s credentialing information with Insurance Companies that the physician participated with
• Maintained patient medical records and submitted copies to interested parties when requested

Northbrook, IL, US

• Responsible for sales, quoting and customer service for a Multi-line Insurance office
• Worked closely with customers to obtain personal information for applications for all lines of insurance policies
• Balanced all daily incoming payments and deposits
• Trained incoming office staff and prepared them for taking state insurance license exams
• Interpreted accident reports and processed small claims
• Oversaw building maintenance and inventory control

High School, Regular/General High School/Secondary Diploma Program

Bachelor Of Science (Bs), Business Administration And Management, General

Associate Of Arts - Aa, Business Administration, Management And Operations