Eboni Smith
Jacksonville,FL
Summary
Experienced healthcare professional specializing in prior authorization management and relationship building with providers and insurers. Proven track record of delivering results in dynamic environments. Proficient in medical coding and knowledgeable in insurance regulations and communication strategies.
Overview
13
13
years of professional experience
Work History
Prior Authorization Specialist
AmeriHealth Caritas
Jacksonville, FL
09.2022 - Current
- Successfully processed and obtained authorization for medical services in a timely manner.
- Navigated multiple systems to efficiently verify pricing and benefits.
- Managed incoming provider calls regarding pending authorization status.
- Interpreted health plan policies to ensure accurate prior authorization decisions.
- Identified areas for improvement in prior authorization processes to enhance efficiency.
- Fostered a collaborative team environment that promoted respect and diversity.
- Escalated issues to supervisors to maintain seamless workflow.
- Utilized data entry skills to input information accurately across various systems.
Provider & Member Service Rep
Payspan Inc
Jacksonville, FL
05.2019 - 03.2021
- Resolved client issues, enhancing service quality and satisfaction.
- Documented interactions for data-driven workflow improvements.
- Facilitated provider registration, ensuring seamless access to services.
- Partnered with team members to troubleshoot provider registration issues, achieving quicker resolutions and reducing escalations.
- Developed a streamlined ticketing process for system interruptions, which significantly reduced downtime for providers.
Insurance Claims Specialist
Prudential Insurance
Jacksonville, Florida
01.2018 - 04.2019
- Maintained detailed records of customer interactions, ensuring swift resolution of issues.
- Reviewed and processed insurance claims, enhancing accuracy and client satisfaction.
- Reviewing various forms related to death reports and processing end of life documentation.
- Implemented a tracking system, improving claims processing speed and customer satisfaction.
- Analyzed policy coverage to ensure compliance with contractual obligations.
- Reviewed insurance policies to ensure compliance and accuracy, leading to marked improvements in claims approval rates.
- Confidently processing claims and updating client's beneficiaries and coverage for different organizations and companies.
- Interpreted legal documents such as contracts, court orders, and settlement agreements for use in determining coverage amounts for insurance payouts.
Loan Servicing Representative
Select Portfolio Servicing
Jacksonville, FL
07.2012 - 10.2017
- Present loan schedules, enhancing customer understanding and satisfaction.
- Resolve account issues promptly, boosting customer trust.
- Guide debt repayment strategies, improving financial outcomes.
- Streamline payment processes, increasing operational efficiency.
- Analyzed customer financial data to recommend tailored loan modifications, resulting in noticeable improvements in repayment success rates.
- Educated clients on debt repayment strategies, facilitating informed decisions that significantly lowered delinquency rates.
Education
Associate in Arts (A.A.) - Culinary Arts
Florida State College Of Jacksonville
Jacksonville, Florida12.2024
High School Diploma - undefined
Samuel W Wolfson Highschool
Jacksonville, Florida05.2004
Skills
- Medical coding (ICD-10, CPT)
- Healthcare compliance (HCPCS)
- Risk assessment techniques
- Customer engagement strategies
- Data management systems
- Support and issue resolution
- Quality assurance practices
- Process improvement initiatives
- Effective time management
- Claims analysis skills
- Salesforce CRM experience
- Regulatory knowledge
- MedD
Timeline
Prior Authorization Specialist
AmeriHealth Caritas
09.2022 - Current
Provider & Member Service Rep
Payspan Inc
05.2019 - 03.2021
Insurance Claims Specialist
Prudential Insurance
01.2018 - 04.2019
Loan Servicing Representative
Select Portfolio Servicing
07.2012 - 10.2017
Associate in Arts (A.A.) - Culinary Arts
Florida State College Of Jacksonville
High School Diploma - undefined
Samuel W Wolfson Highschool