Crystal Johnson

I’m a Healthcare Operations, Process Improvement, and Compliance professional with 20+ years of experience supporting Medicare, Medicaid, CMS-regulated programs, claims operations, auditing, quality assurance, customer experience, and team leadership. I’m recognized for driving efficiency, improving quality metrics, supporting CMS audit readiness, and resolving complex operational issues.

In my current role at ELEVANCE HEALTH / ANTHEM, I lead enterprise process improvement initiatives that enhance operational efficiency, regulatory compliance, and quality outcomes. I manage CMS reporting, complaint tracking, audit preparation, compliance reviews, and corrective action activities—while performing operational, quality, and compliance audits to ensure adherence to CMS, HIPAA, and organizational requirements.

I focus on root-cause problem solving and workflow optimization. I analyze performance trends, identify process gaps, and implement workflow improvements to reduce risk and improve customer outcomes, and I develop procedures, job aids, training materials, and standard operating processes that support business objectives.

I also strengthen performance through training, onboarding, refresher education, and coaching, improving employee performance and quality metrics. I support Appeals & Grievances operations, Medicare complaint resolution, escalation management, and member advocacy initiatives, while processing, reviewing, researching, and adjusting medical claims with accuracy and compliance as my baseline.