Tiffany Johnson

About Tiffany Johnson

Highly motivated, Claims Specialist with Ullico, Inc processing high dollar Stop Loss…

Experience

1. Claims Specialist

   Ullico Inc

   Apr 2017 — Present · Silver Spring, MD, US

   Receives monthly stop loss reporting from varies ASO’s and TPA’s. Emails reporting to varies stop loss carriers on a daily/monthly basis. Tracks and provides accurate and timely notifications of Trigger Diagnosis and 50% of specific deductible to stoploss carriers. Monitor files for fraud. Ensure fraudulent claims are documented and reported. Reviews pre-authorizations for reporting for notification purposes. Tracks and Files stop loss claims - initial, subsequentand/or final filings, making sure all necessary documentation is included and submitted in a timely manner. Request from broker, group, and administrator necessary documents to file stop loss claims. Ability to read and understand contracts - Reinsurance contracts and Summary Plan Descriptions (SPD) to audit for any potential gaps in coverage. Maintains guidelines and notes with detail to enable accurate claims examination. Maintains Turnaround Time (TAT) guidelines and accuracygoals with filing of Aggregate and Specific stop loss claims. Reviews accuracy of claims included with reimbursement requests to prevent additional delay.claim has been received by the carrier. Emails reimbursement EOR’s to the clients including a cover letter explaining payment. Maintenance of stop loss spreadsheets and stop loss files Follows-up on any initial filings at 3 weeks and subsequent filings at 2 weeks including documentation on specific stop loss spreadsheet as to follow-up date and why reimbursement has not been received. Communication directly with stop loss underwriters Possesses a thorough knowledge of coding structures and claim forms (CPT, HCPCS, UB/Revenue codes, ICD 9/10 etc.) Knowledgeable of Coordination of Benefits (COB). Performs duties in a HIPAA compliant manner. Complies with company policies and procedures as outlined in the Employee Handbook. Complies with departmental policies and procedures.

Education

• Jefferson County High School

  High School Diploma, College/University Preparatory and Advanced High School/Secondary Diploma Program

  1998 — 2000

• Everest University-Tampa

  Associate, Science; Criminal Investigations

  2007 — 2010