Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kelly Smith

Scottsburg,IN

Summary

Highly-motivated and dedicated employee with 30+ years experience in customer service, billing, reporting and compliance with the desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills.

Overview

28
28
years of professional experience

Work History

CASE MANAGER

PharmaCord
Jeffersonville, IN
12.2023 - Current
  • Welcome calls to the patient and healthcare provider
  • Benefit investigations/insurance navigation
  • Assist the patient with financial assistance
  • Prior authorizations/appeals
  • Strong communication with patient, healthcare provider and speciality pharmacy
  • Follow up with all parties throughout their journey.

UM Admin Coordinator 3

Humana
Louisville, KY
12.2018 - 12.2023
  • Assessed customer complaints to determine eligibility for appeal or grievance filing
  • Researched case files to ensure accuracy of information prior to making decisions on appeals or grievances
  • Analyzed complex cases to determine appropriate resolution in accordance with relevant laws, regulations and organizational policies
  • Processed appeals submitted by customers regarding denied or reduced benefits under their Medicare plan
  • Maintained positive working relationship with fellow staff and management.

Senior Billing Representative

Humana Government Business
Louisville, KY
11.2001 - 12.2018
  • Researched, analyzed and resolved customer billing inquiries
  • Generated patient statements and invoices accurately within specified deadlines
  • Assisted customers in resolving billing discrepancies
  • Processed credit card payments via secure online systems
  • Answered incoming customer inquiries regarding product and service information
  • Maintained a high level of professionalism while interacting with customers via phone or email
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations
  • Answered inbound calls, chats and emails to facilitate customer service
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor.

Billing and Claims Representative

Nortons-DBA Fincastle Medical Group
Louisville, KY
06.1996 - 11.2001
  • Reviewed and processed medical insurance claims for accuracy, completeness and compliance with insurance regulations.
  • Assisted patients in understanding their bills and provided guidance regarding payment options.
  • Conducted follow-up calls with third party payers to check on claim status and resolution.
  • Provided customer service support by responding promptly to phone calls from patients seeking assistance with billing issues.
  • Created invoices for services rendered in order to collect payments from patients directly.
  • Documented all efforts made towards collections including letters sent and phone conversations.
  • Posted charges, payments and adjustments.
  • Maintained working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third-party billing requirements.

Education

High School Diploma -

Floyd Central High School
06.1989

Skills

  • Strong verbal and written communication skills
  • Regulatory Compliance
  • Customer Service
  • Medical billing/inquiries
  • Excels in fast-pace environment
  • Autonomous and Self-Directed
  • Detail oriented
  • Microsoft Word
  • Excel
  • Microsoft Teams

Timeline

CASE MANAGER

PharmaCord
12.2023 - Current

UM Admin Coordinator 3

Humana
12.2018 - 12.2023

Senior Billing Representative

Humana Government Business
11.2001 - 12.2018

Billing and Claims Representative

Nortons-DBA Fincastle Medical Group
06.1996 - 11.2001

High School Diploma -

Floyd Central High School

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Kelly Smith