DEBORAH SMITH
Ocala
Overview
30
30
years of professional experience
Work History
Emergency Department Registration Specialist
University of Florida, College of Medicine
Ocala
12.2024 - Current
- Verified insurance information and collected necessary documentation from patients.
- Coordinated communication between patients and healthcare providers for seamless service.
- Assisted in maintaining accurate patient records in the electronic health system.
- Trained new staff on registration protocols and customer service standards.
- Ensured compliance with privacy regulations during patient interactions and data handling.
- Verified insurance coverage for incoming patients and ensured that all documents were accurate and up-to-date.
- Maintained confidentiality of all protected health information as required by HIPAA regulations.
- Processed payments from patients or third party payers accurately and in a timely manner.
- Utilized multiple computer systems to access patient information, update records, verify insurance eligibility.
- Provided excellent customer service to patients and their families regarding registration process.
- Identified areas where improvements could be made in the registration process and worked with management on implementing changes.
- Explained forms and documents to patients, guardians and family members, distributing copies and confirming comprehension.
- Worked with nurses and other clinic staff to process patients and direct to appropriate departments.
- Carefully checked insurance information for benefits coverage and input pre-authorization documents into system.
- Contacted insurance carriers to verify coverage, copays and deductible information for patients.
Customer Service Leader
Hannaford-Delhaize
11.2023 - 06.2024
- Assign activities to front end/kiosk associates according to Service Leader assignment sheets
- Handle cash pickups/drop-offs as needed by cashiers
- Perform cashier/bagging functions
- Assist in special projects and other functions as Needed
- Observe security standards and report to manager or security any abnormal behavior
- Perform all other duties as assigned
Quality Audit Lead
Community Health Options
05.2023 - 11.2023
- Monitor and participate in all quality audit programs
- Compile, report and present claim audit program results, both from internal and partner vending auditing
- Identify individual quality and accuracy areas of concern and collaborate with team members
- Review results of audit finding appeals and determines needed education and process improvement within audit team
- Assist the Configuration, Claims Operations and other departments with quality audit initiatives
- Monitor and drive audit program for adjudicators for process improvement
Reinsurance Analyst
HEALTH PLANS INC.
08.2021 - 05.2023
- Reinsurance Analyst acts as liaison between the reinsurance community and HealthPlans Inc
- Responsible for calculating specific deductibles and submitting filings to Reinsurance carriers
- Initiate requests for funding/reimbursement from clients
- Pull & provide reports as requested by clients or in-house requests
- Gather & pull all pertinent documents, reports and information necessary for filings (Eligibility, Accident details, FMLA, etc.)
- Conduct financial audits on each submission and reconcile at end of contract year
- Maintain files of all submissions and reimbursements/checks received
- Provide summary of filings to clients when requested
Billing Specialist/Patient Care Coordinator
CAPE INTEGRATIVE HEALTH
10.2020 - 08.2021
- Greets patients, answers phones, and performs clerical duties as needed.
- Ensures that all necessary demographic, billing, and clinical information is obtained and entered in the registration system.
- Schedules, reschedules, confirm and cancel patient appointments according to established protocol.
- Performs miscellaneous tasks: gathering & distributing mail, copying, filing, and typing.
- Verifies insurance benefits and may obtain precertification/authorization, as necessary.
- Submit claims timely and accurately to Insurance payers.
- Perform follow-up on all unresolved claims.
- Research denials and/or underpayments and formulate appeal letters and/or disputes.
- Post payments to the AR system.
- Work with other members of the collections team to determine and carry out the best method to resolve delinquent accounts.
- Act as point of contact for all internal and external billing inquiries.
- Respond to patients' questions or complaints regarding their accounts or the billing procedures.
- Maintain strictest confidentiality.
- Perform other tasks as required.
Server
FRYEBURG HOUSE of PIZZA
01.2017 - 01.2019
Receptionist
INNOVATIONS HAIR SALON
01.2017 - 01.2018
Front Desk Receptionist
PORTLAND RADIO GROUP
01.2017 - 01.2018
Claims Auditor/ Quality Coach
MARTIN'S POINT HEALTHCARE
Portland
01.2011 - 01.2016
- Audited a department of 18 claims examiners per month for claim payment/denial accuracies.
- Worked to ensure claims are processed in accordance with provider contracts, member benefits and authorization and regulatory requirements.
- Analyzed payments, procedures and guidelines of benefits according to documentation.
- Identify under and over payment system processed claim error trends and work closely with appropriate departments on resolution.
- Completed weekly and monthly claims' reports to summarize findings regarding errors and recommend corrective actions.
- Identify training opportunities for claims examiners in order to improve accuracy and production.
- Assisted in providing training when needed.
- Held weekly meetings to address error trends and work on corrective actions to resolve.
- Provided one on one support to the claims examiners in order to improve self-confidence, and supply any additional training needs.
Business Analyst
ANTHEM BCBS OF MAINE
South Portland
01.2010 - 01.2011
- Developed and documented test matrix and user cases for business implementation.
- Determined specific business needs and document business requirements for internal and external customers.
- Developed project plans, identified and coordinated resources involving other departments to determine best approach for project implementation.
- Effectively worked with programming staff to ensure requirements are incorporated into system design and testing, resulting in improved quality.
- Ensured all tests were conducted and documented appropriately resulting in improved accuracies improving overall customer satisfaction.
- Took assigned project from original concept through final implementation, defining project scope and objectives, eliminating unnecessary procedures.
- Reduced errors by acting as sole point of contact to users of software to address questions and issues.
Research Adjuster
ANTHEM BCBS OF MAINE
South Portland
01.2001 - 01.2010
- Researched, analyzed and adjusted incorrect claims payments and trends on all lines of business for Maine, New Hampshire and Connecticut.
- Worked to identify over payments and underpayments to providers and performed necessary adjustments.
- Identified documentation gaps and assisted in creating workflows and processes for improvements of documentation and user guides resulting in fewer processing errors.
- Identified and maintained problem log of system issues in order to submit for system updates, reducing company costs and improving customer satisfaction.
- Initiated improved training methods by assisting in training fellow research adjusters on various systems and processes.
- Led team of adjustors in the migration of Virginia research work and correspondence to Maine.
- Utilized and interpreted medical coding including ICD-9 and HCPC coding for claims, improving customer and provider relations, reducing turn-around time.
Provider Service Representative
ANTHEM BCBS OF MAINE
South Portland
01.1998 - 01.2001
- Provided professional assistance to providers, quoted benefits, advised and educated on best billing practices.
- Researched and analyzed claim payment and benefit issues in a timely manner, improving overall provider satisfaction.
- Worked closely with adjustors and various departments to resolve complex provider inquiries and identified trends resulting in improved claims processing and benefit quoting accuracy.
- Identified processes and best practices, and put into place new user guides and documentation to maintain positive provider relations.
- Knowledgeable and proficient in all lines of business, including managed care, indemnity and Medicare, resulted in consistent customer and provider satisfaction.
- Developed strong background in medical terminology and claims coding, strengthening my ability to interpret and assist in coding claims as needed.
Claims Processor
ANTHEM BCBS OF MAINE
South Portland
01.1996 - 01.1998
- Processed claims according to benefits for all lines of business.
- Assisted in the reduction of high claims inventories and correspondence.
- Conducted processing of non-standard benefits for special groups.
- Reduced inventory by coordinating claims handling and investigations, consistently meeting excellent quality and production standards.
- Consolidated claims error reports and documentation resulting in improved overall quality, reducing future claims processing errors.
- Researched and learned policy and benefit interpretation maintaining a high level of knowledge to educate customers and providers.
- Maintained a superior quality rating in processing of claims, consistently meeting quality and production goals.
Education
AS - Paralegal Studies, Accounting
Andover College
Portland, MESkills
- Verification of insurance
- Patient registration
- Electronic health records
- Precertification processes
- Compliance with HIPAA
- Customer relationship management
Timeline
Emergency Department Registration Specialist
University of Florida, College of Medicine
12.2024 - Current
Customer Service Leader
Hannaford-Delhaize
11.2023 - 06.2024
Quality Audit Lead
Community Health Options
05.2023 - 11.2023
Reinsurance Analyst
HEALTH PLANS INC.
08.2021 - 05.2023
Billing Specialist/Patient Care Coordinator
CAPE INTEGRATIVE HEALTH
10.2020 - 08.2021
Server
FRYEBURG HOUSE of PIZZA
01.2017 - 01.2019
Receptionist
INNOVATIONS HAIR SALON
01.2017 - 01.2018
Front Desk Receptionist
PORTLAND RADIO GROUP
01.2017 - 01.2018
Claims Auditor/ Quality Coach
MARTIN'S POINT HEALTHCARE
01.2011 - 01.2016
Business Analyst
ANTHEM BCBS OF MAINE
01.2010 - 01.2011
Research Adjuster
ANTHEM BCBS OF MAINE
01.2001 - 01.2010
Provider Service Representative
ANTHEM BCBS OF MAINE
01.1998 - 01.2001
Claims Processor
ANTHEM BCBS OF MAINE
01.1996 - 01.1998
AS - Paralegal Studies, Accounting
Andover College