Angela Smith
Fort Worth,TX
Summary
Detailed, hardworking, driven Claims Team Lead with over 20 years experience in Manage Care. Eager to obtain a position with an organization that provides an opportunity to strengthen and diversify my skills and experience, with potential for advancement.
Overview
23
23
years of professional experience
1
1
Certification
3
3
years of post-secondary education
Work History
Claims Team Lead
Cook Children's Health Plan
Fort Worth, Texas
02.2016 - Current
- Manage inventory, work with management to mitigate high priority issues and implement proper division of responsibilities daily.
- Develop training and SOP guidelines that communicates clear, concise directions to employees.
- Release high dollar claims.
- Maintain knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Interview and train new employees for production positions.
- Resolve State complaints and appeals using problem-solving skills.
- Identify system workflow requirements to enhance team efficiency.
Patient Account Representative
Cook Children's Medical Center
Fort Worth, Texas
03.2011 - 02.2016
- Worked with outside entities to resolve issues with billing, claims and payments.
- Electronically submitted bills according to compliance guidelines.
- Audit , correct and release claim holds pending provider dictation.
- Knowledgeable in complex benefit levels, limitations and coverage issues.
Customer Service Representative
Alphine Access
Denver, CO
08.2007 - 03.2011
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided primary customer support to internal and external customers.
- Provided information regarding charge accounts.
Claims Re-pricer Level 4
PHCS
New Orleans, LA
08.2002 - 01.2006
- Determined pricing applications and manual calculations of hospital/professional claims submitted electronically/mailed by reviewing type of bill, DRG codes, HCPC and ICD-9.
- Responsible for written and oral communication with providers and clients regarding claims submissions.
- Participated in team-building activities to enhance working relationships
SmartPlan 65 Claims Analyst
The Oath Of Louisiana
New Orleans, LA
01.1998 - 11.2002
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Carried out day-day-day duties accurately and efficiently
Education
Medical Billing And Coding
Remington College
Fort Worth, TX 06.2010 - 04.2011
Nursing Administration
Delgado Community College
New Orleans, LA 08.1991 - 04.1993
Skills
- Special Projects
- Procedure Skills
- Leadership
- Standard Operating Procedures
- Optum CES
- MS Word, Excel, Outlook
- Tapestry
- Legacy DST AS400
- 3M Coding and Reimbursement
- Healthcare Common Procedures Coding System (HCPCS)
Certification
- Certified Coding Specialist - 2011
Timeline
Claims Team Lead
Cook Children's Health Plan
02.2016 - Current
Patient Account Representative
Cook Children's Medical Center
03.2011 - 02.2016
Medical Billing And Coding
Remington College
06.2010 - 04.2011
Customer Service Representative
Alphine Access
08.2007 - 03.2011
Claims Re-pricer Level 4
PHCS
08.2002 - 01.2006
SmartPlan 65 Claims Analyst
The Oath Of Louisiana
01.1998 - 11.2002
Nursing Administration
Delgado Community College
08.1991 - 04.1993
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