Nashoni Smith
Lauderdale Lakes,FL
Summary
Seasoned Medical Claims Specialist with a robust background in healthcare and insurance verification, notably at CodeMax Medical Billing. Excelled in enhancing financial efficiency and client satisfaction through meticulous claims management and customer service. Achieved significant reduction in aging medical claims backlog, demonstrating a blend of analytical prowess and empathetic communication.
Overview
9
9
years of professional experience
Work History
Medical Claims Specialist
CodeMax Medical Billing
Fort Lauderdale, FL
09.2024 - Current
- Verified the Auth with the start and end date, level of care, substance abuse diagnosis codes, number of billable units, revenue codes, and CPT codes
- Followed up on Medical Claims via Availity, and other insurance portals and noted claim status in CollabMD
- Called insurance payers to check the status of denied claims, claims in process, or paid
- Obtained SIU letter, termed coverage or (COB) coverage of benefits needed to resolve claim payment issues
- Updated my Excel spreadsheet to reflect new CollabMD notes
- Contacted the eligibility and benefits department to verify the status of the member's healthcare benefits
- Uploaded requested medical records to the insurance carrier to justify medical necessity
Member Service / AR Manager
Cat Cay Yacht Club
Fort Lauderdale, FL
06.2023 - 07.2024
- Create new member accounts in Jonas accounting software and maintained member files for resigned members
- Resolved customer inquiries on statements via calls and emails, ensuring high satisfaction rates
- Created an excel spreadsheet to track member issues and late fee removals
- Prepared monthly statements by adding fee schedule, late fees, CHIT or point of sale purchases
- Faxed, emailed, and mailed member statements
- Scheduled meetings to discuss actions that would improve the members interaction with our members first website
- Prepared daily bank deposits, check scans, and processed lockbox payments, maintaining financial accuracy
- Generated Aging Reports for overdue accounts, improving account management and collections
Patient Account Coordinator
ABA Centers of America
Lauderdale Lakes, FL
11.2022 - 03.2023
- Contacted insurance carriers to verify insurance coverage and authorization number to have denied claims reprocessed or appealed
- Worked in behavioral health and substance abuse setting were I followed up on medical claims via Availity for updates from insurance payers
- Updated medical claims statuses and notes in CollabMD such as claim still processing, paid or denied
- Called insurance and requested to reissue checks that were lost in the mail etc
- Resolved insurance carrier issues to maintain cash flow, improving financial efficiency
- Submitted Medical Records to Insurance Companies as needed to process claims
- Did daily reports in CollabMD for my assigned facilities or a specific patient
- Updated my Excel spreadsheet daily
- Utilized remittances and EOBs to accurately post patient payments
Live-In Caregiver
Personal Home Health Care
North Lauderdale, FL
06.2021 - 12.2022
- Cooked and served meals to clients according to dietary needs.
- Organized oral medications for clients following dosage and schedule requirements.
- Organized recreational activities such as movies, walks outdoors or music listening sessions.
- Assisted clients with maintaining good personal hygiene.
- Performed chores and light housekeeping around client's residence.
Medical Claims Specialist
MTI America
Deerfield Beach, FL
01.2020 - 10.2022
- Followed up daily with insurance companies to verify claim status and coverage for open claims in the 60 and 90-day period
- Detailed documentation of insurance updates on the patient's account
- Submitted medical records via fax or through Availity
- I reviewed company contracts and verified Authorization or preapproval for CPT codes and number of units billed
- Appealed denied claims and verified CPT codes, reviewed EOBs, and used the review to appeal claims and increase company revenue
- I Managed 42 insurance carriers, reducing the aging medical claims backlog significantly
- I Prepared daily bank deposits and financial reports, ensuring precise and timely financial tracking
- I Accessed financial information to answer client queries, enhancing client satisfaction
- Scanned, saved, and electronically stored EMR health records and medical claim forms
- Mailed out CMS claims to insurance carriers for payment
Elderly Caregiver
Personal Home Health Care
Fort Lauderdale, FL
03.2020 - 09.2020
- Assisted with personal care activities, such as bathing, dressing and grooming.
- Helped client with medication self-administration.
- Entertained, conversed with or read aloud to patients to maintain mental health and alertness.
- Cared for patients by assisting with personal hygiene tasks and completing basic household chores.
Health Service Specialist III
MDLIVE Telehealth
Sunrise, FL
12.2015 - 12.2019
- Registered patients, verified insurance, processed copayments, and scheduled consultations for dermatology, mental health counseling, urgent care, and primary care appointments
- Educated patients on all medical services offered and provided technical assistance with creating their patient profiles on the Mdlive App or uploading pictures and photos for doctor review
- Responded to patient inquiries via phone, chat, email, ensuring HIPAA compliance
- Assisted patients with status updates, pharmacy updates, and photo uploads for consultations
- Documented each patient encounter, which served as a relevant history of contact
- Coordinated with medical providers to assist patients in the waiting room and monitor consultation wait time
Education
Associate's degree - Healthcare Administration
Broward College
Fort Lauderdale, FL12.2024
HHA Certificate - Nursing
Center For Careers And Training
Lauderdale Lakes, FL09.2024
College Diploma - Human Resource Management
Ashworth College
04.2019
Certificate - Customer service and personal development
Youth Enhancement Service
12.2005
Skills
- Behavioral Health
- Healthcare
- Insurance verification
- Customer service
- Insurance claims
Timeline
Medical Claims Specialist
CodeMax Medical Billing
09.2024 - Current
Member Service / AR Manager
Cat Cay Yacht Club
06.2023 - 07.2024
Patient Account Coordinator
ABA Centers of America
11.2022 - 03.2023
Live-In Caregiver
Personal Home Health Care
06.2021 - 12.2022
Elderly Caregiver
Personal Home Health Care
03.2020 - 09.2020
Medical Claims Specialist
MTI America
01.2020 - 10.2022
Health Service Specialist III
MDLIVE Telehealth
12.2015 - 12.2019
Associate's degree - Healthcare Administration
Broward College
HHA Certificate - Nursing
Center For Careers And Training
College Diploma - Human Resource Management
Ashworth College
Certificate - Customer service and personal development
Youth Enhancement Service
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