Miya Smith
Philadelphia,PA
Summary
Extensive experience exceeding 20 years in Medical Administration and Human Services, focusing on case management and financial aid for hospital admissions. Facilitated communication between consumers and insurance providers, confirming coverage and eligibility. Delivered continuous support for consumers with MR/MH disabilities in residential facilities. Strong organizational skills and adept in software applications such as Word Perfect and Microsoft Word.
Overview
23
23
years of professional experience
Work History
Quality Assurance Specialist
Leidos Company/ QTC Management
01.2017 - Current
- Oversaw successful completion of QTC Medical Quality Assurance Training Program.
- Delivered quality assurance for both general and specialty examination reports.
- Guaranteed timely, high-quality submission of medical reports.
- Liaised with physicians and healthcare extenders to offer specific feedback as needed.
- Regularly achieved personal productivity and quality objectives.
- Executed other projects and tasks as designated by management.
Medical Billing Specialist
Onward Behavioral Health
01.2016 - 01.2017
- Computing balances, recording billing payments and compiling account statements for company.
- Calculating penalties, interest and late fees for clients who are past due on their payment and accounts.
- Responsible for preparing invoices for the delivery of goods or services rendered.
- Navigate systems such as Excel, Microsoft Word, Web ex, Fax com
Health Services Specialist
Cigna Health Spring
01.2015 - 01.2016
- Coordinate Hospital, Pre Op, Referral, Home Healthcare and Durable Medical Equipment Authorizations
- Collect correct data i.e. Diagnosis and Procedure codes for proper submission for the Approval of services
- Obtain Healthcare Medicare Advantage benefits and Authorizations
- Research appeals on submitted and denied claims
- Navigate systems such as Citrix, QNXT Excel for utilizations purposes
Consumer Billing Representative
Independence Blue Cross
01.2014 - 01.2015
- Prepare assessment reports and develop training sessions to the introduction of new services launched by the organization for 10+ representatives.
- Track call results, conduct quality assurance and trend analysis based on results of one-on-one monitoring and improve quality and training needs.
- Provide customer service for members pertaining to their premium invoice and payment status.
- Navigate systems such as; Highmark, Insing and Enrollment Communications Systems (ECS) to find correct information for customer and take customer payments as requested by the member.
Medical Billing Specialist/Customer Service
Baird Respiratory Therapy, Inc
01.2005 - 01.2013
- Provide technical and clerical support for Durable Medical Equipment provider, manage all aspects of intake, verifying eligibility using; NaviNet (IBC) portal, EVS (Medicaid) portal and Bright Tree (Medicare) portal.
Unit Clerk/Psychiatric Technician
Belmont Center for Comprehensive Treatment
01.2003 - 01.2005
- Assisted with care of psychiatric patients under the supervision of a Registered Nurse.
- Escorted patients to scheduled ECT treatments, prep patients for treatment, checked vitals before and after treatment.
Education
A.A.S. - Mental Health/Social Services
Community College of Philadelphia
Philadelphia, PA01.2003
Skills
- Attention to detail skills
- Assurance of quality
- Analytical capabilities
- Problem-solving expertise
- Decision-making skills
- Analysis of data
- Documentation practices
- Resolution of issues
- Technical documentation skills
- Techniques for quality management
- Focus on customer needs
- Compliance with regulations
- Planning corrective actions
- Leadership abilities
- Discretionary judgment
- Monitoring performance levels
- Creation of test cases
- Effective test planning
- Mentorship for staff members
Timeline
Quality Assurance Specialist
Leidos Company/ QTC Management
01.2017 - Current
Medical Billing Specialist
Onward Behavioral Health
01.2016 - 01.2017
Health Services Specialist
Cigna Health Spring
01.2015 - 01.2016
Consumer Billing Representative
Independence Blue Cross
01.2014 - 01.2015
Medical Billing Specialist/Customer Service
Baird Respiratory Therapy, Inc
01.2005 - 01.2013
Unit Clerk/Psychiatric Technician
Belmont Center for Comprehensive Treatment
01.2003 - 01.2005
A.A.S. - Mental Health/Social Services
Community College of Philadelphia
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