Monique Johns Email & Phone Number

• Follow up on outstanding Facility claims in Epic
• Compare payments received to current provider/payor contracts to ensure accuracy of payments. Complete write-offs and contractual adjustments as necessary.
• Identify and research claim denials.
• Initiate Clinical Appeals and Underpayment Appeals as necessary.
• Correct patient Eligibility/Enrollment issues to ensure claims are billed accurately and correctly.
• Bill balances to patients as necessary.

Monroeville, Pennsylvania, United States

• Followed up on Home Infusion invoices submitted to Insurance companies to ensure prompt and timely payment and escalate issues as necessary.
• Evaluated payments/denials received for correctness and ensure that they are applied appropriately.
• Drafted written Appeals and Grievances when applicable for denied claims.
• Identified bad debt write-offs and A/R adjustments. Initiate write-off and adjustments in accordance with policies and procedures.
• Ensured that secondary bills and patient invoices are accurately generated and submitted on a timely basis.
• Identified any overpayments and/or duplicate payments, investigate and resolve balances. Process refund requests, in accordance with policies and procedures.

Pittsburgh, Pennsylvania, United States

• Reviewed charts and applied the proper HCPCS and ICD-10 codes
• Verified patient's insurance via phone or online payer portals
• Initiated prior authorization requests when applicable
• Billed Ambulance claims according to payer guidelines via HCFA 1500, electronic, etc.
• Handled AR Review/Collections
• Reviewed electronic and paper rejections/denials

Pittsburgh, Pennsylvania, United States

• Utilized Accounts Receivable reports and identified accounts that are past timely payment
• Made contact with insurance companies, vendors and patients to learn the status of payments
• Drafted appeals, grievances and reconsideration requests to insurance companies to overturn denied or short paid DME claims
• Re-billed claims that have not been received by insurance company/vendor and provide substantiating documentation if necessary
• Obtained necessary documentation (updated medical orders/prescriptions, clinical notes, etc.) and submitted to insurance carrier for reconsideration of claims
• Contacted patient, physician offices, and territory managers to relay and/or obtain pertinent information and/or documents necessary to aide in the collection of claims

Monroeville, Pennsylvania, United States

• Analyzed insurance payments based on current U&C and contract pricing to ensure services have been reimbursed properly and accurately
• Systematically initiate collection calls to insurance companies and prepare collection letters in accordance with targeted goals and department policies
• Maintained bad debt at a percentage level of sales as outlined by department management
• Assured timely submission and resolution of reimbursement appeals/grievances
• Resolved internal and external customer questions including support to other departments with accounts receivable related inquiries
• Resolved reimbursement discrepancies and maintain customer assistance programs

Pittsburgh, Pennsylvania, United States

• Handled the daily operations of the drug utilization review (DUR) initiatives within the Medical and Pharmacy Affairs Department
• Closed and Incentive Formulary exception requests
• Handled Prior Authorizations
• Managed Rx Coverage edits
• The DUR programs are applicable across all lines of business (HMO, POS, PPO, Indemnity, Medicare Part D, etc.); I served as a front--line DUR representative by taking incoming phone calls and answering questions about.
• Answered cases generated and forwarded by external providers and other departments as well as questions from internal sources including, Member Services, HMS, and Sales.

Pittsburgh, Pennsylvania, United States

• Provided prompt, accurate and courteous replies to written and telephonic inquiries involving a variety of issues including benefits, pricing, premiums, claim rejects and claim status
• Responsible for handling a large volume of incoming calls from subscribers, providers, groups, agent plans and the general public
• Required to meet daily evaluated quality and productivity standards
• Provided services as a dedicated customer service rep for numerous clients
• Served as the primary contact person for HR representatives at employer groups whom had their health insurance benefits with Highmark.
• Responsible for handling inquires received via incoming calls, fax and e-mail as well as written correspondence