MAKAYLA SMITH
Fort Worth
Summary
Results-driven healthcare administration professional with 6 years of experience in member eligibility verification, insurance coordination, and claims support. Proficient in utilizing systems including Medical Necessity Reviews, optical character recognition, and electronic data interchange to verify benefits, resolve discrepancies, and facilitate accurate and timely claims processing. Skilled in collaborating with health plans and providers to confirm coverage details, policy limitations, and coordination of benefits (COB). Demonstrate strong knowledge of HIPAA compliance and organizational policies while maintaining confidentiality and accuracy in all processes. Recognized for exceptional customer service, attention to detail, effective communication, and contributing to a collaborative team environment.
Overview
8
8
years of professional experience
Work History
Correspondence Specialist
Ventra Health
Fort Worth, TX
08.2025 - 02.2026
- Consistently met deadlines on projects requiring collaboration across multiple departments within the organization.
- Managed follow-up processes for workers' compensation claims to ensure timely resolution.
- Assisted in processing work comp claims and adjustments efficiently. Supported the printing of necessary documentation for claims. Facilitated timely adjustments to ensure smooth claims handling.
- Executed printing of workers' compensation claims alongside medical records for distribution.
- Assisted in processing claim denials efficiently, ensuring timely resolution for clients. Supported teams in identifying and addressing reasons for claim denials, enhancing workflow. Facilitated efforts to prevent future claim denials through comprehensive analysis and action plans.
- Oversaw research and resolution of incoming medical billing correspondence within revenue cycle management operations.
- Managed research, resolution, and documentation of incoming correspondence through mail, email, and telephone.
Eligibility Research Representative II
American Specialty Health
11.2020 - 06.2025
- Conduct eligibility and coverage verification for members across various systems including Medical Necessity Reviews (MNR), Optimal Character Recognition (OCR), Electronic Data Interchange (EDI), ensuring timely and accurate data processing.
- Review and process compliance claims and clinical claims, maintaining adherence to organizational and regulatory standards.
- Identify and resolve discrepancies in member coverage to ensure accurate claim processing and reduce denial rates.
- Maintain and update member records with verified insurance information while ensuring data accuracy and integrity.
- Regularly communicate with health plans and providers via phone, portals, and clearinghouses such as Availity to verify policy details, benefit limitations, and coordination of benefits (COB).
- Ensure full compliance with HIPAA regulations and uphold confidentiality standards when handling sensitive member information.
- Maintain up-to-date knowledge of evolving healthcare regulations through regular completion of compliance and regulatory training modules.
- Assist in the training of new hires by providing hands-on instruction, mentoring, and guidance on company systems, policies, and best practices.
- Remote
Crew Member
McDonald's
Fort Worth
05.2018 - 11.2020
- Delivered fast, friendly, and accurate service in a high volume, fast-paced environment, ensuring customer satisfaction.
- Prepared and assembled food orders according to company standards and safety protocols, maintaining high quality and consistency.
- Operated registers and handled cash, credit, and mobile transactions accurately while providing excellent customer interaction.
- Assisted in inventory restocking, product rotation, and waste reduction efforts to support daily operations.
- Handled customer complaints professionally and escalated issues to management when necessary to ensure positive outcomes.
- Monitored drive-thru times and worked with team members to consistently meet service time goals.
- Followed food safety procedures and company policies to ensure safe handling, preparation, storage of food.
Education
Bachelor of Science - Finance
Louisiana State University
Shreveport, LA05.2026
Bachelor of Arts - General Studies
Tarrant County College
Fort Worth, TX05.2022
Skills
- Attention to detail
- Adaptability
- Multitasking
- Time Management
- Data Entry
- Problem Solving
- Dependability
- Claims Processing
- Insurance Eligibility Verification
- Data Analysis
Accomplishments
Maintained a QA score of 97.7% at American Specialty Health for 3 years.
Timeline
Correspondence Specialist
Ventra Health
08.2025 - 02.2026
Eligibility Research Representative II
American Specialty Health
11.2020 - 06.2025
Crew Member
McDonald's
05.2018 - 11.2020
Bachelor of Science - Finance
Louisiana State University
Bachelor of Arts - General Studies
Tarrant County College