Heather Smith

Work History

PharmaCord

02.2023 - Current

Enhanced office productivity by handling high volume of callers per day.
Subject Matter Expert for completing the department's adverse events, Product complaints, special situation reports and/or medical inquiries received in accordance with PharmaCord's Business Rules
Overview the department's Field Reimbursement Managers escalations & completed appropriate & timely responses
Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
Provides personalized case management to patients and providers including outbound communication to referral sources, and patients to communicate benefit coverage and next steps in obtaining coverage
Identifies and communicates patient's plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions to providers
Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and providers to follow up on proper submission and/or outcome
Coordinated shipment of products through patient assistance program and/or bridge program from the PharmaCord pharmacy
Triaged patients to internal or external resources as appropriate
Documents all activities within the PharmaCord CORscend system in accordance with business requirements.

LifeSpring Health

02.2018 - 02.2023

Utilizes multiple EMR software
Develops case plans and documentation
Ability to serve as a liaison between the clients, their families, and healthcare professionals
Works independently to effectively demonstrate time management
Processes and maintains clients' state and federal benefits
Applied on clients behalf Medicare, Medicaid, and federal benefits
Closely monitors & meets deadline dates
Able to complete requests for Social Security benefits
Follows through on issues related to insurance eligibility issues/approval of benefits
Processes appeals for state & federal denials for benefits
Traveling to clients to accommodate client's needs
Maintains relationships with patients' insurance payors, families, guardians, & providers during the duration of active care plans
Commutes to outer counties to provide support & training for new office staff.
Provided crisis intervention support for clients experiencing emergencies, using appropriate techniques to de-escalate situations safely.
Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
Monitored clients' progress and tracked client services to provide crisis interventions.

National Nursing & Rehab

09.2015 - 09.2017

I started as an Intake Clerk after my 90 days, I was promoted into the Intake Coordinator position
I was the initial contact to introduce our services to the patients, & families
Provided a supportive explanation to patients of any out-of-pocket cost & the referral process
Completed a EMR inputting patient's demographics, & payors
Verified Commercial, Medicare, & Medicaid policies
Point of contact to Physicians offices communicating updates, obtaining any missing paperwork that we would need to process the referral accurately
Followed policies & procedures to keep the company in guidance for audits
Submitted prior authorizations for initial evaluations & DC Planning for patients
Manages pending admissions, new admissions, and any outstanding items
Creates accurate and timely documentation
Training with new employees on internal systems, policies, & procedures for the department.
Supported office staff and operational requirements with administrative tasks.
Documented patient medical information, case histories, and insurance details to facilitate smooth appointments and payment processing.
Coordinated with healthcare providers to ensure accurate and timely sharing of patient information, enhancing continuity of care.

Optum Health

Jeffersonville , In

10.2013 - 09.2015

Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
Developed in-depth understanding of insurance policies and procedures
Utilized software tools for effective tracking, analysis, and reporting on key performance indicators within the payment processing function.
Provided coaching and mentoring to employees.