ALECIA SMITH
Denver,CO
Summary
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking a proactive approach to identifying and addressing issues, with a focus on optimizing processes and supporting team objectives.
Overview
1
1
Certification
21
21
years of professional experience
Work History
Adj Lead Research and Resolution (NW)
Kaiser Permanente
Aurora, CO
02.2023 - Current
- Team Support:
- Lead NW Region Rework
- DLP walkthrough/training
- Performed Side by Sides
- QA Error Review-COGS Manual error pivots decreased by 20%
- Rework ROLL REPORTS Hyperloop/CRM/Adjustments
- Review aged inventory over ten days, identify potential issues early, and prioritize timely resolution, ensuring efficient inventory management.
- Escalate aged inventory to the relevant department to facilitate prompt action and prevent backlog accumulation, supporting overall process efficiency.
- Aged reworks claim examiner assignments ensure clear ownership and timely processing, reducing delays in claim resolution.
- High Dollar Interest and Penalty Report
- I&P Data Analysis Report
- Claim Escalation Support:
- Escalated claim root cause research/analysis
- Communicate problems/trends to Management.
- Audits
- SME for internal/external audit reviews and findings
- Pre-release review/Audit Review Reports
- Rework findings audit review for team feedback
FP Claims Examiner Lead (NW)
Kaiser Permanente
Aurora, CO
01.2021 - 02.2023
- Assisted in managing inventory processes to support team objectives. Organized and maintained inventory records for accurate tracking. Collaborated with team members to ensure timely stock availability.
- Identified and escalated aged inventory concerns to appropriate departments to streamline processing and reduce backlog.
- Monitored and addressed outstanding high-definition claims to maintain operational efficiency.
- Evaluated QA CRMs for HD and organized materials for leadership release.
- Compiled and delivered high-definition reports for leadership review.
- Assisted in compiling detailed FP roll reports. Supported team members in tracking project progress and updates. Facilitated communication between departments regarding project statuses.
- Analyzed aged inventory trends over a ten-day period.
- Facilitated escalation of aged inventory to relevant departments for resolution.
- Oversaw claim examination assignments to ensure compliance with industry standards.
- Assisted teams in achieving project goals within specified timelines. Supported various groups to meet project objectives effectively. Provided help to team members in managing their tasks efficiently.
- Facilitated knowledge sharing by answering team questions and clarifying complex topics.
- Assisted in conducting DLP walkthroughs and training sessions. Supported team members in understanding DLP processes and protocols. Facilitated training materials for effective knowledge transfer.
- Assisted teams in delivering projects on schedule and within budget parameters. Supported project activities through collaboration and coordination with stakeholders. Contributed to project completion by maintaining organized communication among team members.
- Assisted in reviewing quality assurance errors to identify improvement areas. Supported teams by analyzing error reports and providing solutions. Collaborated with colleagues to enhance QA processes and reduce error rates.
- Provided comprehensive support for claim escalations to enhance customer satisfaction and operational efficiency.
- Facilitated escalation of claim root cause research and analysis processes.
- Identified and communicated emerging problems and trends to management for strategic decision-making.
- Assisted in conducting audits to identify areas for improvement. Supported teams in evaluating compliance with established standards. Helped document findings and recommendations for future audits.
- Collaborated with stakeholders to address audit findings and implement corrective actions for continuous improvement.
- Assisted in compiling pre-release review reports for project teams. Supported audit review processes by gathering necessary documentation. Facilitated feedback collection for pre-release evaluations.
- Collaborated with team members to evaluate and interpret audit findings, ensuring clarity and actionable insights.
- Evaluated complex claims for accuracy, identifying discrepancies and recommending resolutions.
Claims Research Technician (HI)
Kaiser Permanente
04.2013 - 01.2021
- Experienced in processing systems and practices. Xcelys, Tapestry
- Process claims, Reversed/Regenerated claims
- Adjustments on Accounts/Audit Accounts, Followed (DLP) Contracts
- Researched and analyzed outstanding charges
- Researched/audited, assuring claims were processed correctly based on “contracts” DLP’s, members' accumulator status
- Reconciled charges based on deductible and OPM have been met
- Analytical and problem-solving ability
- Works-Cat Tool, CHATS/CRM/CEP’s SharePoint/escalated issues spreadsheet
Collections Cash Receipt (PFS)
Kaiser Permanente
02.2012 - 04.2013
- Submitted appeals to insurance companies to have original denials overturned for payment. Calls made to insurance companies to verify if the payment was made
- Collected on self-pay/Insurance accounts
- Experienced in processing systems and practices. Xcelys
- Analytical and problem-solving ability
- Post Internal Remits (835) Post Commercial, W/C HRI, Insurance & Self-pay payments Medicare posting
Patient Financial Services
Kaiser Permanente
06.2011 - 02.2012
- Worked side by side with the Manager/Supervisor
- Assist the Manager in escalated conference calls to resolve issues/problems
- Disburse emails to the team about the resolution.
- Worked on Xcelys spreadsheet- Documented incorrect accounts
- Worked Internal Follow up- WQ’s/Denial WQ’S/Upheld Review WQ
- Medicare Advantage Follow-up/Denial WQ’S in (Xcelys, Q-Care)
- Experienced in processing systems and practices. Xcelys, Tapestry
- Researched and analyzed outstanding charges
- Reconciled charges based on deductible and/or OPM have been met
- Reviews and Analyzes Financial information
- Analytical and problem-solving ability
- Inbound/Outbound Calls
- Set up payment plans (PFS)
- Applying Credit Balances/Refunds (PFS)
- Trained four Employees. (On-the-job training) Leadership skills
INSURANCE REP/COLLECTOR
Office Team- PFS Group
11.2010 - 05.2011
- Follow up by phone with Insurance carriers for claim status
- Reviewed denied claims for payment
- Researched/audited customer accounts thoroughly and documents appropriately
- Resubmit claims to assure complete and correct payment
A/R COLLECTOR
Ledgent - Apria Healthcare/Coram
09.2010 - 11.2010
- Research overdue account balances that are partially/fully unpaid
- Follow up by phone or mail to Insurance carriers on delinquent payments
- Denied claims for payment and underpaid claims
- Responding to customer inquiries (account status)
- Researched/audited customer accounts thoroughly and documented appropriately
- Resolves discrepancies and prepares adjustments and refunds
- Timely Reimbursement Initiates payment and resubmits bills as necessary
Insurance Rep
Rubin & Raine
06.2008 - 06.2009
- Responsible for all Commercial primary and secondary claims; insured claims have been resolved promptly.
- Submitted appeals to insurance companies to have original denials overturned for payment.
- Work aged accounts to resolve claim discrepancies
- Resolved patient complaints with Insurance carriers and facilities
- Contact insurance companies daily via the Web, Email, or phone to collect and verify insurance information to resolve claim issues.
- Extensive clerical skills, high volume of keyboarding tasks, and able to oversee multiple phone tasks
- Bill UB-04, UB-92, and CMS 1500 claim forms
- HIPAA Compliant
- Reviewed/audited payments and adjustments for Exempla Health systems.
- Worked on billing reports to resolve claim billing discrepancies for Exempla Health
Medical Billing/Electronic Claims Entry/Coding
Littleton Pediatrics
05.2007 - 05.2008
- Entered charges from Superbills
- Processed electronic Claims (EDI)Auditor
- Go to the person for IT issues
- ICD 9, CPT CODING
Customer Service Collections
Scott Lowery Law Firm
10.2006 - 03.2007
- Medical complex collections for self-pay
- Skip traced
- Made payment arrangements and notated the account
- Spoke with Customers about their balances
Any Position
Spherion (Temp) Services
10.2005 - 09.2006
Charge Entry/Electronic Claims/Coding Medical Billing/Accounts Receivable
Colorado Family Medicine
05.2005 - 09.2005
- Charge entry, electronic claims, processing claims, appeals, and coding for Medicare, Medicaid, and commercial
- Composed and mailed payment arrangement letters
- Posting Payments: Commercial, Medicare, and Medicaid
Education
Diploma - Medical Billing/Insurance Coding
Everest College
Aurora11-2010
Skills
- Leadership skills, Hotel front desk/Customer Service, Keyboarding, Alpha Numeric- Data Entry, Charge Entry, 45 wpm, Receptionist
- Medical Billing, Claims Adjuster, Lead FP claims processor, Lead Adj Research and Resolution, Collections/Poster, Accounts Receivable/Payables, CPT Coding, ICD9, CMS 1500, UB04, Referrals/Audit accounts
- Compatible with MS Office Excel, Word, Cashier, 6line PBX
- Knowledge of Misys, Verses, NextGen, Medisoft, and Companion Practice Management
- IDX, CARS, DMS, EPREMIS, CMS, CWMS-REPORTS, Horizon-Plus, Health Connect, Xcelys, Tapestry-EPIC
- Problem-solving
- Customer service
- Teamwork and collaboration
- Friendly, positive attitude
Certification
- Diagnosis Coding Using ICD-9-CM
- CMS Form 1500 (08/05), World of Medicare (01/10)
Timeline
Adj Lead Research and Resolution (NW)
Kaiser Permanente
02.2023 - Current
FP Claims Examiner Lead (NW)
Kaiser Permanente
01.2021 - 02.2023
Claims Research Technician (HI)
Kaiser Permanente
04.2013 - 01.2021
Collections Cash Receipt (PFS)
Kaiser Permanente
02.2012 - 04.2013
Patient Financial Services
Kaiser Permanente
06.2011 - 02.2012
INSURANCE REP/COLLECTOR
Office Team- PFS Group
11.2010 - 05.2011
A/R COLLECTOR
Ledgent - Apria Healthcare/Coram
09.2010 - 11.2010
Insurance Rep
Rubin & Raine
06.2008 - 06.2009
Medical Billing/Electronic Claims Entry/Coding
Littleton Pediatrics
05.2007 - 05.2008
Customer Service Collections
Scott Lowery Law Firm
10.2006 - 03.2007
Any Position
Spherion (Temp) Services
10.2005 - 09.2006
Charge Entry/Electronic Claims/Coding Medical Billing/Accounts Receivable
Colorado Family Medicine
05.2005 - 09.2005
Diploma - Medical Billing/Insurance Coding
Everest College
KP KUDOS
Awarded- KP KUDOS recognized for outstanding Attention to detail, which resulted in excellent quality, dedication, and commitment being met.