Summary
Overview
Work History
Education
Skills
Timeline
Generic

Donna Smith

Leander,TX

Summary

Consistent professional with substantial experience in the healthcare industry and expertise in claims adjudication and revenue. Committed to boosting production, decreasing costs and increasing efficiency.

Overview

11
11
years of professional experience

Work History

Patient Demographic/ Charge Entry Manager

RC Billing
04.2021 - Current
  • Manage multiple employees in our demographics and charge entry department for 26 clients across the United States.
  • Provide training and assistance to employees to ensure claims are processed correctly.
  • Create training documents on correct procedures and practices. Research Medicare, Medicaid and commercial plans and how they should be handled.
  • Work charge corrections and merge patient accounts.
  • Collaborate with other departments to streamline the revenue cycle process for our claims
  • Work with our EDI department on failed claims and how to rectify those


Business Operations Manager

Centene
09.2019 - Current
  • Develop and manage methodologies for tracking, identifying and problem-solving issues, interpreting and presenting program results and insights, and developing data-driven analysis approach for clients
  • Perform data analysis from a variety of data sources to evolve the metrics used to measure effectiveness and return on investment of all current and new product activity
  • Collaborate with staff to identify internal and external customers and their expectations, initiate process changes to increase quality, decrease costs and improve staff, provider and member satisfaction
  • Facilitate and support operations staff in the planning, achievement, and tracking of the organizations key strategic initiatives to create a positive impact on organizational scorecard
  • Serve as an internal resource and advisor on improvement activities
  • Explore new approaches to work processes by utilizing quality improvement techniques to eliminate waste and re-work

Process Analyst II

Cenpatico
06.2015 - 09.2019
  • Investigated, analyzed and reviewed claims to identify and resolve issues.
  • Reviewed state documentation to identify any program changes.
  • Assisted with system updates and communication of changes to stakeholders.
  • Audited provider set up and submitted provider set up corrections.
  • Facilitated meetings with provider relations and clinical staff.
  • Assisted in identifying methods to reduce the volume of pended and adjusted claims and recommended solutions to increase auto-adjudication rates.
  • Submitted projects to pay claims that were denied in error.
  • Trained new employees on the BSO processes and procedures.
  • Processed weekly check runs for various markets
  • Created monthly reports
  • Responded to CRM inquiries regarding claims processing and sent CRM cases to have issues resolved.
  • Completed internal audit reviews.

Product Specialist

E-MDs
01.2013 - 05.2015
  • Conducted meetings and discussions to achieve consensus on product features and functionality.
  • Researched the existing product and customer requests to determine the desired functionality for a new product line.
  • Created wireframes of proposed UI for the assigned modules.
  • Wrote functional specifications through the Design, Development and QA processes.
  • Communicated with high-level personnel; Sales, Senior Management, Support, Development, QA and external customers, including providers, billing staff, CEOs, CFOs, etc.
  • Organized and prioritized many high priority items and determined strategic goals.

Education

High School Diploma -

Leander High School
Leander, TX

Skills

Results-oriented

Client-focused

Computer proficient

Reports generation and analysis

Training and Development

Proficient in Excel

29 years of Revenue Cycle management

Data Analysis

Staff Management

Managing multiple projects simultaneously

Timeline

Patient Demographic/ Charge Entry Manager

RC Billing
04.2021 - Current

Business Operations Manager

Centene
09.2019 - Current

Process Analyst II

Cenpatico
06.2015 - 09.2019

Product Specialist

E-MDs
01.2013 - 05.2015

High School Diploma -

Leander High School

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Donna Smith