Katie Smothers
Mount Morris,USA
Summary
Insightful Appeals Analyst known for high productivity and efficient task completion. Possess specialized skills in regulatory compliance and case management. Utilize critical thinking, communication, and problem-solving abilities to excel in challenging situations. Committed to delivering precise analysis and fostering positive outcomes in all endeavors.Over 15 years of experience in managing both administrative and clinical duties.
Overview
15
15
years of professional experience
Work History
Medical Denial and Appeals Analyst
McLaren Regional Medical Center
Flint, Michigan
03.2023 - Current
- Analyzed patient records to support appeal decisions and recommendations.
- Reviewed appeals for accuracy and compliance with regulations and policies.
- Communicated with healthcare providers to gather necessary documentation for appeals.
- Prepared detailed reports outlining appeal findings and rationale for decisions.
- Managed denials and special circumstances by ensuring timely follow-up with relevant parties to facilitate resolution.
- Advised management on best practices for resolving difficult claims disputes.
- Assisted in developing new processes designed to improve efficiency within the Appeals department.
- Actively monitored progress on pending appeal cases ensuring timely completion of tasks associated with each claim dispute resolution.
- Coordinated with various departments to gather necessary information, enhancing chances for successful appeal resolutions.
- Provided guidance and assistance to other departments regarding the appeals process.
- Attended meetings with management staff concerning policy changes impacting the appeals process.
- Developed strategies that streamlined resolution processes for appeals, improving overall case handling.
Medical Administrative Assistant
Ascension Together with Compassus
Grand Blanc, US
12.2021 - 03.2023
- Schedule patient appointments for nine clinicians
- Managed sensitive information according to HIPAA regulations to ensure patient confidentiality. in a confidential matter-HIPPA compliance
- Managed sensitive information according to HIPAA regulations to ensure patient confidentiality. in a confidential manner-HIPAA compliance
- Audit charts for insurance surveys
- Provide general support to patients, families, and community personnel to enhance care experience
- Acted as physician liaison and facilitated referrals from multiple hospitals and physician offices.
- Scanned documents into EHR systems according to established protocols.
Certified Medical Assistant/Receptionist
AscensionHillside Center
Grand Blanc, US
05.2017 - 06.2019
- Greeted patients and visitors with courtesy and professionalism, enhancing their experience
- Maintained accurate electronic medical records for patient information and communication.
- Coordinated patient scheduling and follow-up appointments efficiently.
- Supported clinical staff in administering vaccinations and other procedures.
- Communicated effectively with patients to address concerns and provide support.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Scheduled appointments for patients via phone and in person.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Interviewed patients to verify information, record medical history and confirm purpose of visit.
- Obtained insurance authorizations for prescribed medications or treatments for patients in need of financial assistance programs.
- Answered multiple phone lines, ensured all patient enquiries were answered in a timely manner
- Administered injections in a clinical setting under physician supervision.
Surgical Coordinator/Certified Medical Assistant
Michigan Neurosurgical Institute
Grand Blanc, US
09.2013 - 07.2016
- Scheduled all in office and hospital operating room surgical procedures.
- Explained surgeries and in-office procedures to patients, alleviating anxieties and enhancing cooperation.
- Maintained and audited the surgery schedule and applied scheduling guidelines in an efficient and equitable manner
- Prepared and provided pre-operative patient packets either in person or by mail, arranged pre-operative testing and exams.
- Advised and counseled patients regarding food, fluid and medication intake and restrictions prior to surgery
- Interacted with many departments/surgical vendors ensuring a proper level of equipment and supplies were available for surgery
- Communicated daily with operating room desk regarding scheduled surgery times
- Prepared patient charts, pre-admissions, and consent forms.
- Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
- Entered orders into the EMR system efficiently and without errors.
- Verified patients' eligibility and claims status with insurance agencies.
- Completed pre-certification for surgeries by verifying insurance coverage and obtaining necessary approvals. and radiology procedures.
- Partnered with practice manager to devise and monitor tools to evaluate and improve health delivery systems
- Trained new and existing staff on new computer systems and facilitated communication between clinic and system support specialists.
Certified Medical Assistant/Referral Specialist
Genesys Heart Institute Physician Group
Grand Blanc, US
02.2012 - 03.2013
- Obtain patient vitals and input data into patients' electronic medical record
- Performed EKG, holter, and event monitor testing per physician orders
- Request referral for patients' upcoming appointments
- Requested prior authorizations from insurance companies to facilitate patient care
- Prepare patients' medical charts for upcoming appointments
- Answer patients' calls and communicate with physicians to update patient status
Education
Associate in Applied Science -
Oakland Community College
Waterford, MIHigh school diploma -
Academy of Academic Excellence
Clarksville, TNSkills
- Electronic Medical Records: Allscripts
- Electronic Medical Records: Mysis
- Electronic Medical Records: Genesys Wellness
- Electronic Medical Records: SISWEB
- Electronic Medical Records: Mclaren Powerchart
- Electronic Medical Records: Revenue Cycle/ Cerner
- Electronic Medical Records: Veracity
- Claims
- Insurance Verification
- Claim adjudication
- Appeals analysis
- Case management
- Medical record management
- Patient Care
- Billing
- Order processing
- Data Entry
- Filing
- Scheduling
- Attention to detail
- Process optimization
- Process improvement
- Communication skills
- Collaborative teamwork
- Proactive mindset
- Problem solving
- Time management
- Prioritization skills
- Efficient and reliable team player
- Multitasking skills
- Reliability
- Team player
- Compassionate care
- Clerical experience
- Investigation management
- Case evaluation
- Microsoft Office Proficiency
- Process improvement
- Insurance verification
- Investigate claims
- Team Training
- Detail orientation
- Critical thinking
- Goal setting
- Professionalism
- Verify data
- Database management
Timeline
Medical Denial and Appeals Analyst
McLaren Regional Medical Center
03.2023 - Current
Medical Administrative Assistant
Ascension Together with Compassus
12.2021 - 03.2023
Certified Medical Assistant/Receptionist
AscensionHillside Center
05.2017 - 06.2019
Surgical Coordinator/Certified Medical Assistant
Michigan Neurosurgical Institute
09.2013 - 07.2016
Certified Medical Assistant/Referral Specialist
Genesys Heart Institute Physician Group
02.2012 - 03.2013
Associate in Applied Science -
Oakland Community College
High school diploma -
Academy of Academic Excellence