Ebony Smith
Louisville,KY
Summary
Results-driven claims processor with extensive experience at UnitedHealthcare, specializing in enhancing customer experience and ensuring compliance with HIPAA regulations. Demonstrated expertise in medical terminology and proficiency in Microsoft Office and claims software, leading to improved processing efficiency and accuracy. A proactive approach and meticulous attention to detail have significantly elevated client satisfaction levels. Committed to leveraging these skills to drive operational excellence in future roles.
Overview
13
13
years of professional experience
Work History
Claims Processor
UnitedHealthcare
06.2024 - Current
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing deadlines.
- Evaluated the accuracy and quality of data entered into CPA and Cosmos.
- Improved speed and accuracy of data entry, utilizing advanced software and technology to support claims processing
- Maintained strict confidentiality when dealing with sensitive information about patients' medical histories or personal details
- Enhanced claim processing efficiency by implementing new software and streamlining procedures PSI, Sophia
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
- Identified trends in denials or rejections due to incorrect coding or billing practices by providers.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
Patient Support Specialist
Liveops
08.2017 - 06.2024
- Followed document protocols to safeguard confidentiality of patient records
- Taught patients and families how to use an at-home medical collection kit.
- Worked flexible hours: night, weekend, and holiday shifts.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Determined prior authorizations for medication and outpatient procedures
- Make adjustments to patients' demographic, insurance, and account balance information
- Researched CPT and ICD-9 coding discrepancies before transferring them to the Billing department
- Continued education on new policies and procedures
- Remote
- Verified patient insurance coverage and eligibility for services.
- Performed data entry of patient information into electronic health records systems.
- Provided emotional support to patients struggling with difficult diagnoses or treatments.
- Reviewed patient data and researched to fill in missing insurance and physician information.
Medical Technician
Guardian Alarm Security
Louisville, USA
10.2017 - 06.2020
- Monitored inventory levels of supplies, equipment and reagents used and placed orders for replacements
- Interviewed patients to obtain medical history
- Interacted with patients and families while demonstrating high standards of performance, teamwork and compassion
- Inspected, tested and calibrated medical equipment before installing
- Diagnosed cause of problems and completed repairs
- Documented information regarding installations, repairs and inventory checks
- Maintained safe work environment and adhered to privacy regulations
- Carried out day-day-day duties accurately and efficiently
- Worked flexible hours; night, weekend, and holiday shifts
- Used critical thinking to break down problems, evaluate solutions, and make decisions.
- Trained patients on how to properly operate medical equipment.
- Participated in continuing education courses related to medical technology advances.
- Performed preventative maintenance, troubleshooting, and repairs on medical equipment.
Medical Collections Representative
National Patient Account Services
Louisville, USA
10.2015 - 08.2017
- Negotiated payment plans with patients in order to collect past due balances.
- Researched and responded to customer inquiries regarding outstanding balances or payment arrangements.
- Processed credit card payments over the phone using secure encryption technology.
- Participated in team meetings and training sessions related to collections procedures.
- Negotiated to collect balance in full
- Processed payments and contracts on accounts
- Counseled debtors on payment options and arranged installment agreements
- Resolved challenging situations with friendly but firm strategies
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor
- Maintained high volume of calls and met demands of busy and productive group
- Processed payments and applied to customer balances
Sales Associate
Uhaul Moving And Storage
03.2013 - 10.2015
- Maintained up-to-date knowledge of store merchandise and policies.
- Demonstrated product features and benefits for customers' needs.
- Answered customer questions regarding sizing, accessories, and proper care for merchandise.
- Engaged with customers to effectively build rapport and lasting relationships
- Achieved perfect attendance and on-time record
- Implemented up-selling strategies such as recommending accessories and complementary purchases to boost revenue
- Tracked stock using company inventory management software
- Consistently maintain call average time
- Met collection quota monthly
Customer Service Specialist
Teleflora
02.2012 - 02.2015
- Performed data entry of customer orders into the company's order management system.
- Addressed customer complaints and mitigated dissatisfaction by employing timely and on-point solutions
- Took payment information and other pertinent information such as addresses and phone numbers to place orders
- Complied with company policies and procedures by encouraging positive and effective work environment among all employees
- Resolved concerns with products or services to help with retention and drive sales
- Described product highlights and benefits to help guide purchasing decisions
- Processed returns, refunds, exchanges according to company policies and procedures.
- Handled over 150 calls per shift, signing up new customers, retrieving customer data, presenting relevant product information, and cancelling services.
Education
High School Diploma -
Washington Park Highschool
Racine, WI06.2003
Skills
- World-Class Customer Experience
- HIPPA training
- Teamwork and collaboration
- Adaptability and flexibility
- Medical Terminology
- Excellent Attention to Detail
- Accuracy and precision
- Microsoft Office
- Claims Processing Software
- Data entry proficiency
- Prior authorization processing
- Problem-solving aptitude
- Critical thinking
- Organizational skills
- Proficient in Epic, Cpa, Sophia, Cosmos
- ICD-10 coding
Timeline
Claims Processor
UnitedHealthcare
06.2024 - Current
Medical Technician
Guardian Alarm Security
10.2017 - 06.2020
Patient Support Specialist
Liveops
08.2017 - 06.2024
Medical Collections Representative
National Patient Account Services
10.2015 - 08.2017
Sales Associate
Uhaul Moving And Storage
03.2013 - 10.2015
Customer Service Specialist
Teleflora
02.2012 - 02.2015
High School Diploma -
Washington Park Highschool