Florentia Smith
Snellville,GA
Summary
Energetic and dedicated medical billing professional with 15+ year of experience, analytical, problem-solving, and decision-making abilities. Seeking career advancement and a challenging work environment.
Experienced Billing and Collections Specialist skilled in analyzing medical documentation and investigating billing patterns. Effective communicator with a strong understanding of compliance standards, dedicated to maximizing collection efficiency and enhancing team engagement.
Overview
20
20
years of professional experience
Work History
Billing and Collections Specialist
Northside Hospital
Fully Remote
02.2020 - Current
- Manage the accurate processing and submission of medical claims, ensuring adherence to all relevant compliance regulations and guidelines.
- Conduct thorough follow-up on outstanding claims to maximize collection efficiency.
- Investigate billing data patterns to inform strategic enhancements in revenue cycle management practices.
- Analyze medical documentation for discrepancies and implemented corrections to maintain accurate billing practices.
- Collaborate with insurance providers and digital platforms to monitor and resolve outstanding medical claims.
- Manage the preparation and submission of disputes, reconsiderations, appeals, and outliers for valid denials. Oversaw collection of clinical documentation to support appeals. Composed detailed appeal letters and liaised with payers for timely resolutions.
Physician Denial Management Specialist
Northside Hospital Atlanta
Atlanta, GA
06.2017 - 02.2020
- Reviewed and interpreted denied claims from medical insurance companies, ensuring compliance with industry standards and regulations.
- Coordinated with internal staff to address denial issues, implementing corrective actions and facilitating claims resubmission.
- Identified patterns in recurring denials and recommended strategic process enhancements to prevent future issues.
- Documented and managed all denial appeals and follow-ups, reinforcing adherence to HIPAA regulations and organizational policies.
DME - Patient Account Coordinator
Lincare Holdings Inc.
Norcross, GA
11.2006 - 02.2018
- Engaged with insurance providers to confirm coverage details, addressing payment discrepancies and streamlining processing timelines.
- Investigated and rectified billing inquiries and discrepancies, guaranteeing correct and comprehensive charge assessments.
- Implemented collection strategies for outstanding accounts, ensuring adherence to company policies and procedures.
- Facilitated submission of medical claims to insurance carriers to maintain compliance with coding standards (CPT/ICD-10) and ensure accurate patient data.
Education
No Degree - Medical Billing And Coding
Ashworth College
Norcross, GASkills
- Data analysis expertise
- Clear communication skills
- Skilled in completing CMS-1500 and UB04 documentation
- Proficient in HCPCS and ICD-10
- DRG analysis expertise
- Understanding of HIPAA standards
- Experience with MedMetrix and Microsoft applications
- Denial resolution expertise
- Healthcare vocabulary expertise
- Effective team engagement
- Strong organizational abilities
Timeline
Billing and Collections Specialist
Northside Hospital
02.2020 - Current
Physician Denial Management Specialist
Northside Hospital Atlanta
06.2017 - 02.2020
DME - Patient Account Coordinator
Lincare Holdings Inc.
11.2006 - 02.2018
No Degree - Medical Billing And Coding
Ashworth College