EBONY SMITH
Pittsburgh,PA
Summary
A dedicated, resourceful, and team-oriented Business Administration and Management professional with 10 plus years of experience. Dependable and organized team player with the ability to communicate effectively and efficiently. Ability to prioritize multiple projects; flexible and dependable with a positive attitude and strong customer service skills.
Overview
11
11
years of professional experience
Work History
Service Coordinator
UPMC
Pittsburgh, PA
07.2023 - 03.2025
- Directed a caseload of 80 clients with 100% success rate in completing service plans within six months of enrollment by showing effective case management and goal oriented support strategies.
- Managed incoming and outbound calls to participants, caregivers and family members. Scheduled assessments in the home and in the nursing facility.
- Advocated for individuals to access necessary services to keep them in there homes and to comply with the waiver program. Ensured monthly contact and provide comprehensive service coordination, Facilitated service planning meetings, Communicated expectations and ensure service coordination.
- Assessed strengths and needs through interviews and reviews, Evaluated services and reviewed cases with relevant parties.
Patient Care Navigator
United Way of Southwestern Pennsylvania
Pittsburgh, PA
11.2021 - 06.2023
- Contacted clients by telephone based on the clients information that was forwarded to the care navigator portal.
- Connected clients with the right healthcare professionals: They help patients find the appropriate doctors, specialists, and other healthcare providers.
- Offered guidance on managing chronic conditions, understanding diagnoses, and following treatment plans.
- Assisted with paperwork and insurance,scheduling appointments, getting prescriptions, and navigating insurance issues.
- Connected patients to programs that provide housing, food, transportation, or other essential services.
- Advocated for patients, which helped patients understand their rights and advocate for their needs within the healthcare system.
- Followed up with patients after hospital admissions to ensure they understand discharge instructions and medications.
Case Manager
ConnectiveRx
Pittsburgh, PA
11.2020 - 07.2021
- Exhibited a leadership role within the assigned territory by managing the Care Coordination process through consistently identifying complex and specific issues and developing action plans accordingly.
- Demonstrated accountability for action plan execution, and energetically drive for success and results.
- Balanced the needs of individual customers (clients, clinics, field representatives, patients, etc.) with the program's contractual obligations.
- Facilitated program services related to authorization and appeal support through tactical communication with healthcare providers, payers, and patients in order to promote product access.
- Maximized speed to therapy by expediting product access channel fulfillment through use of technology, understanding of the payer landscape, access requirements, and customer preferences.
- Provided claim support by answering medical billing inquiries and coordinating payer review of denied or underpaid claims.
- Delivered education and access to financial assistance offerings, including client sponsored copay programs, patient assistance programs, charitable organizations and voucher offers by assessing customer eligibility based on the program guidelines.
- Maintained comprehensive understanding of the reimbursement process, billing/coding requirements, insurance plans, payer trends, and related resources.
- Verified insurance coverage for new patients and re-verifed insurance coverage for existing patients.
- Identified training opportunities, contribute to training activities, and create/update program SOPs and other tools as needed.
- Participated in special projects and perform additional duties as required.
Provider Services Representative/Enrollment
Gateway Health Plan
Pittsburgh, PA
08.2017 - 11.2020
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Inputted all communication with applicants into computer system to facilitate future clarification and knowledgeable support.
- Improved customer satisfaction by finding creative solutions to problems.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Listened to and understood customers' needs, explained and discussed options and outlined best-fit services.
Customer Service Representative
Highmark Blue Cross Blue Shield
Pittsburgh, PA
08.2014 - 04.2017
- Informed customers about billing procedures, processed payments and provided payment option setup assistance.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Delivered high level of service and support to each customer, paving way for future business opportunities.
- Reviewed account and service histories to identify trends and issues.
- Set up and activated customer accounts.
- Educated customers on special pricing opportunities and company offerings and Documented conversations with customers to track requests, problems and solutions.
- Maintained calm, friendly demeanor with upset customers to de-escalate stressful situations.
- Consulted with customers to determine best methods to resolve service and billing issues.
- Evaluated customer account information to assess current issues and determine potential solutions.
Education
Master of Science - Business Administration
Point Park University
Pittsburgh, PA04.2017
Bachelor of Science - Business Management
Point Park University
Pittsburgh, PA04.2005
Skills
- Insurance billing
- Business operations
- Relationship development
- Process improvement
- Cross-functional collaboration
- Patient assessment
- Invoice generation
- Communications
- Ability to enter data
- Customer support and assistance
- Progress evaluations understanding
- Technologically advanced
- Emotional awareness
- Problem resolution
- Project Organization
Timeline
Service Coordinator
UPMC
07.2023 - 03.2025
Patient Care Navigator
United Way of Southwestern Pennsylvania
11.2021 - 06.2023
Case Manager
ConnectiveRx
11.2020 - 07.2021
Provider Services Representative/Enrollment
Gateway Health Plan
08.2017 - 11.2020
Customer Service Representative
Highmark Blue Cross Blue Shield
08.2014 - 04.2017
Bachelor of Science - Business Management
Point Park University
Master of Science - Business Administration
Point Park University