Adrienne Smith
Palmyra,NY
Summary
I have an extensive background in computers, customer service, medical fields and quality assurance for a federal government contractor. I am a hard worker and fast learner. I have excellent communication and interpersonal skills.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Patient Access Representative
Rochester Regional Health-Newark, NY
02.2024 - Current
- In a customer service oriented manner, interviews patients and/or their representative to collect required registration data, to include but is not limited to; demographic and financial data as well as obtain required signatures, communicates mandated patient information and verifies all information for accuracy
- Process includes but is not limited to insurance verification, obtaining pre-certification and/or authorization, co-payment collection and communicating with patient and/or their representative with regards to their financial assistance needs
- Manages incoming calls while providing necessary information
- Greeting of patients and/or their representatives and providing direction as needed
- Scheduling patient appointments
- Interviewing the patient and/or their representative for necessary information and completing the registration process as defined by departmental policy
- Identification of services where no payment source has been identified to be followed up by communication of financial assistance and/or payment arrangements
- Verification of insurance eligibility/coverage and obtaining necessary pre-certification's/authorizations when applicable
- Collecting/processing co-payments, deductibles and/or other types of payments
- Provides an estimate of cost when applicable
- Reviews charges in charge review WQs for completeness and accuracy
- Ensures the accuracy of all data collected while meeting the regulatory requirements as outlined by the departmental policy
- Communication with external customers such as but not limited to; payers, physician offices and other departments
- Accurately sets up new patient record via Care Connect
- Performs other duties as assigned.
Senior Appeals Specialist
Maximus Federal Services-Remote
08.2019 - 02.2024
- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position
- Function as a Subject Matter Expert in one or more process areas
- Analyze data submitted for Independent Medical Review
- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system
- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.
Medical Receptionist
WESTFALL CARDIOLOGY-Newark, NY
09.2017 - 08.2019
- Serves as the first point of contact, providing exceptional customer service, when greeting and serving all patients and visitors
- Answers phones, routing telephone calls and/or creating patient cases as appropriate
- Returns patient voice and/or email messages in a timely manner
- Schedules appointments in the electronic health record
- Assists in maintaining the provider(s) schedules by moving patient appointments, following up on no-shows, and reminding patients of upcoming appointments
- Completely documents all required demographic information in the patient's electronic health record, updating at each visit as appropriate
- Scans patient registration and all other relevant documentation into the patient's electronic health record
- Verifies patient's insurance and obtains prior authorizations
- Educates patients on the sliding fee scale discounts and determines patient eligibility for the sliding fee scale through verification of income
- Documents insurance policies and sliding fee scale policies appropriately in the patient's electronic health record
- Obtains signed release forms from patients
- Responsible for maintaining the patient reception area in a clean, neat and presentable condition
- Obtains patients' payments at the time services are rendered
- Follows the daily financial audit checklist and participates in the end of the day reconciliation process
- Exemplifies and demonstrates positive teamwork with all providers, administrative and clinical staff
- Ensure timely response to appointment messages and requests via the phone and portal
- Participate as a member of a patient's care team
- Ensure patients receive a copy of his/her visit summary
- Ensure patients leave with an appointment and face no barriers regarding transportation
- Other administrative and clerical duties as assigned.
Access Associate-Floater
Newark Wayne Community Hospital-Newark, NY
09.2016 - 08.2017
- In a customer service oriented manner, interviews patients and/or their representative to collect required registration data, to include but is not limited to; demographic and financial data as well as obtain required signatures, communicates mandated patient information and verifies all information for accuracy
- Process includes but is not limited to insurance verification, obtaining pre-certification and/or authorization, co-payment collection and communicating with patient and/or their representative with regards to their financial assistance needs
- Manages incoming calls while providing necessary information
- Greeting of patients and/or their representatives and providing direction as needed
- Scheduling patient appointments
- Interviewing the patient and/or their representative for necessary information and completing the registration process as defined by departmental policy
- Identification of services where no payment source has been identified to be followed up by communication of financial assistance and/or payment arrangements
- Verification of insurance eligibility/coverage and obtaining necessary pre-certification's/authorizations when applicable
- Collecting/processing co-payments, deductibles and/or other types of payments
- Provides an estimate of cost when applicable
- Reviews charges in charge review WQs for completeness and accuracy
- Ensures the accuracy of all data collected while meeting the regulatory requirements as outlined by the departmental policy
- Communication with external customers such as but not limited to; payers, physician offices and other departments
- Accurately sets up new patient record via Care Connect
- Performs other duties as assigned.
Quality Technician III
Maximus Federal Services-Pittsford, NY
10.2005 - 09.2016
- Monitor and evaluate inbound and outbound calls, data entry, faxes, emails and other transactions against established standards and criteria
- Maintain accountability for accurately completing observations using required systems and tools
- Communicate key insights and findings to management
- Successfully participate in calibration sessions to ensure alignment to overall Quality Assurance (QA) vision
- Analyze and develop routine ad hoc reports on project performance and research and suggest solutions to identified issues
- Conduct daily monitoring activities and audits for quality assurance purposes and to support the effective functioning of the project
- Analyze quality assurance data to identify trends and to develop and implement corrective action plans for review and approval of management
- Coordinate with the training team and participate in front-line staff training for the purpose of achieving and maintaining exceptional quality assurance goals
- Maintain overall balanced performance (productivity, attendance, etc.)
- Retain current knowledge regarding applicable policies, processes and regulations
- Research and gather data for special projects and initiatives
- Participate in routine meetings with program management in performance of QA calibrations
- Use all available resources to complete an appropriate assessment
- Perform other duties as assigned by management.
Education
Master's degree - Emergency Services Management
Columbia Southern University
06.2024
Bachelor's degree - Health Care Administration
Columbia Southern University
03.2024
Associate's degree - Criminal Justice
Everest College-Phoenix
07.2007
Associate's degree - Liberal Arts & Sciences
Finger Lakes Community College
12.2001
Skills
- Microsoft Office
- Documentation review
- HIPAA
- Leadership
- Workday
- Microsoft Outlook
- Anatomy knowledge
- Data science
- Research
- Cold calling
- Medical Receptionist
- Insurance Verification
- Medical records
- SharePoint
- Workers' compensation law
- Quality assurance
- EMR systems
- Google Suite
- Organizational skills
- Workers' Compensation
- Customer service
- Typing
- Training & Development
- Medical terminology
- Curriculum development
- Project management
- Hospital experience
- Root cause analysis
- Marketing
- Continuous improvement
- Communication skills
- Computer skills
- Microsoft Excel
- Risk management
- Microsoft Word
- Healthcare management
- Epic
- Social media management
- Sales
- Data collection
- Human resources
Certification
Driver's License
Timeline
Patient Access Representative
Rochester Regional Health-Newark, NY
02.2024 - Current
Senior Appeals Specialist
Maximus Federal Services-Remote
08.2019 - 02.2024
Medical Receptionist
WESTFALL CARDIOLOGY-Newark, NY
09.2017 - 08.2019
Access Associate-Floater
Newark Wayne Community Hospital-Newark, NY
09.2016 - 08.2017
Quality Technician III
Maximus Federal Services-Pittsford, NY
10.2005 - 09.2016
Master's degree - Emergency Services Management
Columbia Southern University
Bachelor's degree - Health Care Administration
Columbia Southern University
Associate's degree - Criminal Justice
Everest College-Phoenix
Associate's degree - Liberal Arts & Sciences
Finger Lakes Community College
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