Fayre Smith
Houston,TX
Summary
Dynamic professional with extensive experience in appeals and grievances, adept at analyzing complex claims and ensuring compliance with regulations. Proven expertise in EHR systems and medical billing, coupled with strong management and customer support skills, driving timely resolutions and enhancing recovery outcomes in fast-paced environments.
Overview
9
9
years of professional experience
Work History
Appeals and Mitigation Eligibility Advisor(Remote)
Texas Health and Human Service Commission
Houston, TX
10.2024 - 01.2026
- Executed comprehensive analysis of client appeals and documentation to determine outcomes.
- Conducted reviews, analyses, and adjudications of Medicaid denials.
- Oversaw compliance with state and federal regulations to effectively resolve disputes.
- Facilitated client correspondence for appeal hearings and phone reviews to ensure informed final determinations.
Accounts Receivable Manager
Suzanne Bruce & Associates
Houston, TX
08.2016 - 02.2020
- Managed collections process and resolved outstanding account discrepancies.
- Evaluated aging reports to prioritize collection strategies and enhance recovery outcomes.
- Ensured timely payments from clients through effective communication and proactive followups.
- Prepared bills receivable, invoices, and bank deposits.
- Processed incoming payments utilizing EMR Nextech system.
- Reconciled daily AR ledger and verified proper accounting posting.
Appeals and Grievances Coordinator (Remote)
Molina Healthcare
Houston, TX
08.2023 - 04.2024
- Oversaw MCO appeals and grievances process to guarantee timely and accurate resolutions for members and providers.
- Analyzed claims appeals and grievances utilizing QNXT systems to establish appropriate determinations.
- Evaluated and analyzed medical records, coverage and eligibility to ensure compliance with protocols.
- Prepare appeal summaries and correspondence, and documents findings accordingly.
Revenue Cycle Specialist(Remote)
Mindpath Health
Houston, TX
05.2022 - 03.2023
- Processed patient billing inquiries, ensuring accurate resolution of issues.
- Collaborated with clinical staff to streamline documentation for timely claims submission for Mental Health Services .
- Oversaw accounts receivable aging reports to ensure timely resolution of outstanding balances.
- Ensured verification of insurance coverage eligibility and prior authorizations using several different payer portals.
Education
Health Information Technology
Lone Star College
Houston, TX06.2027
Skills
EHR/EMRsystems (Epic, Cerner, Advanced MD, and Nextech)
Knowledge of insurance plans (Medicare, Medicaid, commercial)
ICD-10, CPT, and HCPCS codes
Medical Appeals and Grievance
Billing and A/R
Management
Customer Support
50 WPM
Microsoft Office Proficiency
Medical Terminology
Mental Health Services
Dermatology Services
LTSS
Authorizations
Claims/EOBs
Patient Intake
Record Management
Document Management
Timeline
Appeals and Mitigation Eligibility Advisor(Remote)
Texas Health and Human Service Commission
10.2024 - 01.2026
Appeals and Grievances Coordinator (Remote)
Molina Healthcare
08.2023 - 04.2024
Revenue Cycle Specialist(Remote)
Mindpath Health
05.2022 - 03.2023
Accounts Receivable Manager
Suzanne Bruce & Associates
08.2016 - 02.2020
Health Information Technology
Lone Star College