Marva Smith
Greensboro,NC
Summary
Dedicated Reimbursement Case Manager with extensive experience in healthcare support, insurance verification, intake, and patient access services. Skilled in benefit investigations, prior authorizations, appeals, and copay assistance to ensure patients gain timely access to therapies. Adept at making welcome and follow-up calls, collecting missing information, and collaborating with providers, payers, and patients to resolve reimbursement issues while maintaining compliance with HIPAA and payer guidelines. Strong background in Medicare/Medicaid, commercial insurance, and specialty pharmacy processes.
Overview
10
10
years of professional experience
Work History
Reimbursement Case Manager
CareMetx
08.2022 - Current
- Manage inbound and outbound calls with healthcare providers, patients, and payers to support therapy access.
- Perform intake and data entry, ensuring cases are accurately created and updated in internal systems.
- Make welcome calls to new patients and conduct follow-up calls to track case progress and therapy initiation.
- Reach out to patients and healthcare providers (HCPs) to collect missing information needed for benefit investigations, prior authorizations, or appeals.
- Conduct comprehensive benefit investigations for commercial, Medicare, and Medicaid plans to determine coverage, eligibility, and patient financial responsibility.
- Initiate and track prior authorizations and appeals, ensuring timely submission of required clinical documentation.
- Collaborate with providers to resolve coverage denials and secure approvals for therapy.
- Educate patients on insurance benefits, copay responsibilities, and available financial assistance programs.
- Maintain compliance with HIPAA and company SOPs when handling sensitive patient data.
Extended Business Office Agent
Meduit
Charlotte, NC
12.2020 - 08.2022
- Managed patient financial accounts by establishing payment plans, processing assistance applications, and explaining insurance benefits, deductibles, and copays.
- Communicated directly with patients, providers, and insurance representatives to resolve billing and coverage issues.
- Delivered accurate data entry and account documentation to support reimbursement workflows.
- Provided compassionate financial counseling to patients, ensuring they understood their responsibilities and available support options.
Release of Information Specialist
Ciox
Alpharetta, GA
02.2019 - 04.2020
- Processed patient medical records requests with strict adherence to HIPAA compliance and confidentiality standards.
- Verified, assigned, and recorded patient record numbers to maintain accuracy in documentation systems.
- Supported providers, patients, and healthcare facilities by ensuring timely and accurate release of records to facilitate care and insurance needs.
- Strengthened administrative processes through efficient data entry, filing, and record management.
Customer Service Professional
BCBSNC
Winston Salem, NC
08.2016 - 04.2018
- Assisted members with insurance coverage, benefits, and claims inquiries, ensuring accurate interpretation of complex plan details.
- Supported Medicare Advantage and Medicaid Advantage case management, helping members navigate coverage, providers, and authorizations.
- Delivered welcome calls and follow-ups to educate members on plan benefits, ensuring smooth onboarding and retention.
- Balanced company policy requirements with member needs to achieve high satisfaction while maintaining compliance.
- Developed strong communication and problem-solving skills, frequently working with elderly members and complex cases.
Education
High School Diploma - Academic
PMHS
Indianapolis, INSkills
- Benefit Investigation (BI) & Prior Authorization (PA)
- Appeals & Denials Management
- Patient & Provider Support
- Welcome & Follow-Up Calls
- Intake & Data Entry
- Insurance Verification (Commercial, Medicare, Medicaid)
- Case Management & Reimbursement Support
- HIPAA Compliance & Documentation Accuracy
- Cross-Functional Collaboration
Timeline
Reimbursement Case Manager
CareMetx
08.2022 - Current
Extended Business Office Agent
Meduit
12.2020 - 08.2022
Release of Information Specialist
Ciox
02.2019 - 04.2020
Customer Service Professional
BCBSNC
08.2016 - 04.2018
High School Diploma - Academic
PMHS