Angela Smith
Danville,IL
Summary
30+ Years of Medical background as a CNA with clinical experience and now as a Managed health care Team player who excels assisting People in healthcare and their medical insurance. Well Knowledge of my field. Claims Process implementation Code validation skills Data entry Self-motivated Active listening skills Documentation Faxing Multitasking Problem solving for quickest resolution for Provider/ Member. Balance Billing Assisting with members and providers on building on building a health home for member. Knowing Medicaid guidelines Meeting Hedis Scores Working multiple software programs Fast learner. Effective Communication skills.
Overview
14
14
years of professional experience
Work History
Wellcare Medicare
Centene
Tampa, FL
12.2023 - Current
- Identified needs of customers promptly and efficiently.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Planned and completed group projects, working smoothly with others.
- Collaborated with others to discuss new opportunities.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Handled modification and updating of policies.
- Worked with team members to promote great customer service and pleasant work environment.
- Attended and participated in meetings and brainstorming sessions with team members.
- Implemented training improvements to achieve desired results.
- Optimized team performance by training new hires on use of equipment, standard procedures, and organizational policies.
Member Service Representative II
Managed Health Services
Indianapolis, IN
09.2018 - Current
- Worked with cross-functional teams and a diverse group of colleagues to achieve team goals and meet customer needs
- Recorded actions taken, issues resolved, and [Type] information to effectively manage customer accounts
- Used resourcefulness, skill, and advanced use of internal knowledge bases to respond to customer requests for products, services, and information
- Provided exceptional customer service and drove retention by communicating accurate information about promotions, customer programs, and products
- Aided customers by carefully listening, identifying problems, and making recommendations based on my extensive product knowledge
- Quickly investigated and resolved customer complaints and inquiries
- Met HEDIS and quality measures
- Managed care for Indiana Medicaid Members.
Care Coordinator II
MDwise
Indianapolis, IN
06.2015 - 03.2018
- Gave patients the tools and knowledge they needed for a quick and long-term recovery
- Motivated members to establish care with their primary care physician
- Worked with patients who had a variety of chronic illnesses, such as COPD and asthma
- Assessed patients who were going through active drug and alcohol withdrawal and offered interventions to help them manage their physical and psychological symptoms
- Provided assistance for Medicaid members that were restricted and assisted to navigate through the insurance side of health care to get their needs met
- Helped with community-oriented public relations
- Guided members and assisted with Pharmacy needs, establishing care with their providers, and community resources
- Met HEDIS and quality measures
- Managed care for Indiana Medicaid Members.
Care Connector
AmeriHealth Caritas Family of Companies
Indianapolis, Indiana
06.2012 - 07.2015
- Gave patients the tools and knowledge they needed for a quick and long-term recovery
- Motivated members to establish care with their primary care physician
- Worked with patients who had a variety of chronic illnesses, such as COPD and asthma
- Assessed patients who were going through active drug and alcohol withdrawal and offered interventions to help them manage their physical and psychological symptoms
- Provided assistance for Medicaid members that were restricted and assisted to navigate through the insurance side of health care to get their needs met
- Helped with community-oriented public relations
- Guided members and assisted with Pharmacy needs, establishing care with their providers, and community resources
- Met HEDIS and quality measures
- Managed care for Indiana Medicaid Members.
Certified Nursing Assistant
Kindred Hospital Indianapolis
Indianapolis, IN
01.2011 - 06.2012
- Increased patient satisfaction by assisting people with personal tasks like dressing and walking
- Built relationships with patients, caregivers, and healthcare professionals in order to help patients achieve their personal care plan goals
- Evaluated patients to identify and address wounds, behavioral concerns and medically relevant symptoms
- Checked patient vitals such as temperature, blood pressure, and blood sugar to stay on top of symptoms and keep [Job title]s informed of changes
- Was a constant advocate for the welfare, rights, and needs of patients
- Followed and enforced safety protocols to protect patients and workers
- Was in charge of monitoring fluid outputs, recording results, and collecting specimens for testing
- Evaluated patients' vital signs, documenting all pertinent data and noting any significant changes to report to RN
- Assisted patients with bathing, grooming, and other hygiene requirements
- Followed all company policies and provided hands-on nursing care to patients under the supervision of an RN
- Blood Draw and specimen collections.
Education
GED -
01.1995
CNA Certificate -
01.1992
Southport High School -
Indianapolis, INArea 30 Career Center -
Greencastle, INSkills
- Claims
- Process implementation
- Code validation skills
- Data entry
- Self-motivated
- Active listening skills
- Documentation
- Faxing
- Multitasking
- Problem solving
- Balance Billing
- Assisting with members and providers
- Knowing Medicaid guidelines
- Meeting Hedis Scores
- Working multiple software programs
- Fast learner
- Effective Communication skills
- CMS guidelines
- Providing Information and Resources
- Administrative and Office Support
- Quality Standards and Protocols
- Resolving Problems
- Explaining Policy and Procedures
Timeline
Wellcare Medicare
Centene
12.2023 - Current
Member Service Representative II
Managed Health Services
09.2018 - Current
Care Coordinator II
MDwise
06.2015 - 03.2018
Care Connector
AmeriHealth Caritas Family of Companies
06.2012 - 07.2015
Certified Nursing Assistant
Kindred Hospital Indianapolis
01.2011 - 06.2012