Danella Smith
Locust Grove,GA
Summary
Knowledgeable Prior-Authorizations with solid history of managing teams and driving operational success. Skilled in implementing strategic initiatives that enhance productivity and efficiency. Demonstrated ability in problem-solving and decision-making. Results-driven management professional with proven ability to lead teams to success. Strong focus on team collaboration, operational efficiency, and achieving measurable outcomes. Adept at strategic planning, process improvement, and fostering culture of accountability and excellence. Known for adaptability and consistently meeting changing organizational needs.
Overview
24
24
years of professional experience
Work History
Insurance Verification/Prior-Authorization Manager
Piedmont Cancer Institute
10.2019 - 08.2024
- Process provider credentialing information, including verification of data in accordance with policies and procedures, to support network development and credentialing processes
- Verify various insurance via web portals
- Ensure accurate demographics and Insurance information is entered into patients accounts
- Obtain radiology prior authorizations for all insurances
- Interacts professionally with providers and ancillary staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment and file maintenance for Medicaid programs
- Run data quality reports and reviews files and online provider databases for accuracy and errors
- Maintains strict confidentiality regarding protected health information understands and adhered to insurance and HIPAA Privacy & Security policies and procedures
- Audits data entered and performed primary source verifications in accordance with various regulatory agencies for credentialing, re credentialing, and delegated accounts
- Offer guidance and support to fellow team members
- Managed and motivated employees to be productive and engaged in work.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Defined clear targets and objectives and communicated to other team members.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Established team priorities, maintained schedules and monitored performance.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Accomplished multiple tasks within established timeframes.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Cross-trained existing employees to maximize team agility and performance.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Maintained professional, organized, and safe environment for employees and patrons.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
- Successfully managed budgets and allocated resources to maximize productivity and profitability.
- Facilitated team brainstorming sessions that led to innovative solutions for long-standing operational challenges.
- Implemented customer feedback mechanisms to gather insights, using this information to guide strategic planning and decision-making.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Learned and adapted quickly to new technology and software applications.
- Strengthened communication skills through regular interactions with others.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Proved successful working within tight deadlines and a fast-paced environment.
- Developed and maintained courteous and effective working relationships.
- Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
- Spearheaded transition to remote work during global health crisis, ensuring business continuity and employee safety.
Billing/Prior Authorizations Manager
InforMD Solutions
09.2000 - 06.2018
- Proficient navigation through EDP systems to input data for processing claims
- Oversees and approves ordering and maintenance of all supplies and equipment
- Managed medical records, obtaining all needed demographics from patients for easy follow up
- Obtain Prior Authorizations for all payers
- Displayed thorough knowledge of insurance policies and process, educating patients as needed
- Ensures requests for information and record releases are handled promptly and effectively to guarantee payment on patient accounts
- Completes any other duties and or special projects as assigned
- Supervised the daily operational functions for the medial office ensuring that office policies, procedures, and plans were executed in a smooth and efficient manner for multiple locations
- Managed the surgical and clinical schedule, financial reporting, insurance verification, pre-certifications, address patient financial obligations and manage petty cash
- Acts as the formal contact person for referring physicians and patient complaints
- Manage the staffing process, including recruiting, interviewing, hiring, and onboarding
- Conduct annual evaluations, providing constructive feedback as needed to boost employee morale and work ethics
- Authorized patient medication request performed appeals and clinical reviews for medication authorization
- Trained back office medical assistants and serve as subject matter expert to current staff
- Organizes and directs the work of the clinical staff, coordinating staff activities and schedules to ensure that effective patient care services are provided while meeting quality standards
- Maintained inventory and ordered back-office supplies monthly
- Assist front office staff with checking-in patients, verifying insurances collecting/posting payments and scheduling appointments
- Addressed and remedied all patient or team member issues.
- Enhanced patient care by establishing strong relationships with medical professionals, including physicians, nurses, and technicians.
- Implemented new processes for managing patient flow, minimizing wait times while maintaining high-quality care standards throughout the practice.
- Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and safeguarding against potential data breaches.
- Managed and motivated employees to be productive and engaged in work.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Defined clear targets and objectives and communicated to other team members.
- Identified and communicated customer needs to supply chain capacity and quality teams.
Education
MASTER OF SCIENCE - Psychology
University of Phoenix
05.2010
bachelor of science - psychology
Southern University
05.1993
Skills
- Microsoft Office
- Exceptional Customer Service
- Data Entry
- Critical Thinker
- Medical Terminology
- EClinicalWorks
- NexGen
- MedTech
- TriZetto
- Problem Resolution
- Quality Control
- Organizational Skills
- Conflict Resolution
- Time Management
- Strategic Planning
- Training & Development
- Leadership
- Epic
- Verbal and written communication
- Complex Problem-Solving
- Team Leadership
Activities
- American College of Healthcare Executives
- Medical Association
Timeline
Insurance Verification/Prior-Authorization Manager
Piedmont Cancer Institute
10.2019 - 08.2024
Billing/Prior Authorizations Manager
InforMD Solutions
09.2000 - 06.2018
bachelor of science - psychology
Southern University
MASTER OF SCIENCE - Psychology
University of Phoenix
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