MELODY SMITH
Washington,D.C.
Summary
To leverage my extensive clinical experience and skills in healthcare administration and management to contribute to a dynamic healthcare organization. Seeking a position where I can utilize my expertise in coordinating benefits and services, managing information systems, and ensuring efficient day-to-day operations, ultimately leading to enhanced staff morale and improved patient satisfaction. Versatile professional serves as first point of contact for patients by verifying insurance, handling paperwork and preparing records. Patient-oriented and helpful candidate familiar with MS Office and EHR systems coupled with thorough knowledge of medical terminology. Committed to providing personalized service and quality patient care.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Admission Coordinator
Luminis Health
01.2021 - Current
- Gather and enter demographic, clinical, and financial information into electronic medical records
- Interview patients to obtain necessary admission details, explain admission forms and policies, collect signatures, discuss financial responsibilities, and obtain payments
- Verify insurance eligibility, obtain insurance notifications, and identify the insurance payer source
- Submit notification to insurance company within 24 hrs of patient Emergency Room Status
- Coordinates peer 2 peer with insurance company and providers for denied authorization
- Submitting and authorizing 40-50 accounts daily.
- Assisted with processing patient admissions, transfers and discharges.
- Entered work orders into computer system for appropriate departments regarding maintenance issues and biomed needs.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
Prior Authorization Coordinator
Savista LLC.
06.2018 - Current
- Verifying patients' insurance information and benefits using various tools, as well as obtaining preauthorization and referrals for services as required by the payer
- Clearing minimum of 35-60 accounts daily
- Communicating and documenting insurance updates, investigating insurance denials, sending appeals to payers, and arranging peer-to-peer discussions for denied authorizations
- Conducting research for accurate billing, providing financial advice and reporting on revenue and collections, complying with Medicare, Medicaid, and Commercial Insurance regulations, assisting with charge entry and payments and resolving pending revenue
- Managing a team of 10 employees, tracking productivity and time, and preparing weekly reports for management on claims denied, claims submitted, and remittance received.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Conducted patient intake interviews, recording and documenting relevant information.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Collected and processed patient liability statements prior to service.
- Tracked referral submission during facilitation of prior authorization issuance.
- Coordinated referrals through insurance and other medical specialists and documented details in patient charts.
- Trained new staff on hospital processes and procedures.
Patient Access
SilverSpring Pediatrics
09.2017 - 01.2020
- Greeting and registering patients, notifying the appropriate team members upon patient arrival
- Collecting and verifying insurance and patient information, ensuring accurate completion of necessary documentation
- Updating any changes to patient, physician, and insurance details for proper billing, collecting co-pays and fees
- Answering and transferring incoming calls, scheduling and managing appointments, pre-registering patients and inputting clinical data
- Responding to patient portal inquiries, obtaining prior authorization for medical record release, providing reports and logs to management as needed, sorting and distributing incoming mail and packages, and assisting with web-enabled patient portal activities.
- Addressed bad debts in line with set protocols.
- Trained new staff on filing, phone etiquette and other office duties.
Patient Access Representative
Howard University Hospital
04.2017 - 09.2018
- Gathering and entering demographic, clinical, and financial information into the Allscript electronic medical records system
- Conduct interviews with patients to obtain necessary information for admission, explain admission forms and policies, collect signatures, and discuss financial responsibilities and payment arrangements
- Perform insurance verification, obtain consent, and provide insurance notifications
- Identifying the insurance payer source and verifying eligibility would be part of your duties as well
- You would also handle charge order entry processing and assist in escorting patients to different departments within the facility.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Facilitated communication between patients and various departments and staff.
Education
High School Diploma -
H.D Woodson
Washington DCMedical Assisting
University of District of Columbia
Washington, DC03.2017
Skills
- Process Management
- Medical Terminology Proficiency
- Data Verification
- Patient Admission
- Admissions Requirements
- Medical Admissions Process Knowledge
- Computer Literacy
- Office Supplies and Inventory
- Financial Verification
- Patient Interviewing
- Patient Referral
- Weekly Payroll
- Well-Versed in Insurance
- Accounts Payable and Accounts Receivable
- Patient Data Management Systems
- Employee Timesheet Processing
- Authorization Procedures
- Electronic Patient Medical Record
- Call Transfers
- Insurance Information Oversight
- Greeting Visitors
- Clinical Messaging
- Referral Tracking
- Past Due Balance Management
- Eligibility Checks
- Prior Authorization Processing
- Demographics Information
- Benefit Coverage
- Patient Identification
- Electronic Health Records Systems
- Private Insurance
- Outpatient Surgery Coding
- Insurance Procedures
- Benefits Verifications
- Patient Scheduling
- CPT Coding
- Data Entry
- Registration Paperwork
- Authorizations
- Retro-Authorizations
Awards And Acknowledgements
Possess a diverse set of skills and training in various areas. Proficient in using Electronic Medical Records (EMR) systems such as Eclinical Works, Office Practicum, Allscript, IDX, and Epic . Experience in conducting insurance verifications and have a strong background in providing excellent customer service. Training includes ethics and HIPAA compliance, certified in CPR. Additional skills in petty cash management, check reconciliation, and accurate data entry.
Certification
- Area of expertise License - Timeframe
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Admission Coordinator
Luminis Health
01.2021 - Current
Prior Authorization Coordinator
Savista LLC.
06.2018 - Current
Patient Access
SilverSpring Pediatrics
09.2017 - 01.2020
Patient Access Representative
Howard University Hospital
04.2017 - 09.2018
High School Diploma -
H.D Woodson
Medical Assisting
University of District of Columbia
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