Jenn Johnston

About Jenn Johnston

As a highly motivated and results-driven Claims Analyst with over 25 years of experience across healthcare administration, claims processing, and customer service, I have built a solid foundation of skills in medical coding, healthcare regulations, and claims adjudication. Holding a Bachelor of Science in Healthcare Management, I am passionate about ensuring accurate and compliant claims processing, while maintaining a strong focus on customer service and team collaboration. Currently, as a Claims Analyst at Pacific Source, I process complex medical claims with a keen eye for detail and compliance, working closely with healthcare providers and patients to resolve discrepancies and streamline the claims process. I have a proven track record in reducing delays and ensuring timely reimbursement through effective use of ICD-10-CM and HCPCS coding systems. Throughout my career, I’ve developed a comprehensive skill set that spans healthcare systems and software, problem-solving, and cross-functional teamwork. I have worked across various roles, from healthcare management to customer service, with experience in prior authorizations, referral management, and operational leadership. My diverse background has allowed me to thrive in fast-paced environments, resolve complex issues efficiently, and collaborate effectively with teams to drive high-quality outcomes. Outside of my professional life, I am passionate about giving back to my community through volunteer efforts, including my roles with Bend South Little League and Pacific Source’s diversity initiatives. I am also a certified First Aid and Mental Health First Aid responder, reflecting my commitment to both health and wellbeing in all aspects of life. I am always eager to connect with professionals in the healthcare and claims processing fields, share insights, and explore new opportunities to drive innovation and excellence in the industry.

Experience

1. Claims Analyst

   PacificSource Health Plans

   Sep 2022 — Present · Bend, OR, US

   Function as a key member of the claims processing team, independently adjudicating complex medical claims while ensuring accuracy and compliance with healthcare regulations, company guidelines, and industry best practices. Utilize strong analytical and research skills to meticulously evaluate medical necessity, determine coverage based on intricate plan benefits and provider contracts, and identify potential fraud or abuse.• Effectively communicate with healthcare providers and patients to clarify information, resolve discrepancies, and obtain missing documentation in a timely and professional manner, fostering positive working relationships. This collaborative approach streamlines the claims processing workflow and ensures a positive experience for all parties involved.• Maintain a high level of accuracy and efficiency by leveraging data entry skills and proficiency in medical coding systems (ICD-10-CM, HCPCS Level II). These skills contribute to a streamlined claims processing workflow and ensure accurate reimbursement for covered services.• Actively contribute to a positive and collaborative team environment by readily sharing knowledge and expertise with colleagues, fostering a supportive and efficient work unit. This commitment to teamwork allows for continuous learning and professional development within the team.

Education

• Wilsonville High School

  High School Diploma

  1997 — 2001

• Ashworth College

  Bachelor of Science - BS

  2023 — 2024

• Oregon State University

  Bachelor of Arts (B.A.)

  2010 — 2013