Pauline Jones Smith

• Preform Receptionist duties in Radiology department, scheduling, filing, and Registration. Communicate with patience and their providers.
• Reviewed files, records and other documents to obtain information to respond to requests.
• Train clerical staff during orientation as well as routing to various workstation.

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• Welcomed customers with friendly greeting, answered general questions, gathered nature of visit and directed to specific offices.
• Confirmed appointments, communicated with clients, and updated client records.
• Supported administrative tasks such as filing, data entry, and document preparation for more efficient office workflow.
• Sorted, received, and distributed mail correspondence between departments and personnel.
• Scheduled appointments accurately.
• Answered multi-line phone system to respond to inquiries and transfer calls to correct departments and personnel.

• Experienced Revenue Specialist with a demonstrated history of working in the medical industry
• Maintains up-to-date knowledge of Medicare, Medicaid and private insurance rules/procedures/and rate of billing.
• Expert knowledge of commerical payers and obtaining prior authorizations.
• Review insurance contracting to verify authorization process by utilizing insurance payer portal.
• Obtained, review and logged input accurate patient insurance, referrals, medical records and demographic information for use by insurance providers and medical personnel.
• Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
• Communicate effectively with patients provider medial offices and insurance companies
• Ability to analyze 30 plus records daily, send/fax request for medical records and fax complete prior authorization form with clinical notes for review for authorization. Follow on authorization status/review edits for denial.
• Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
• Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
• Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
• Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
• Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
• Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
• Excellent communication skills, both verbal and written.
• Passionate about learning and committed to continual improvement.
• Self-motivated, with a strong sense of personal responsibility, with minimal supervision.
• Delivered services to customer locations within specific timeframes.
• Provided professional services and support in a dynamic work environment.

• Exhibited high energy and professionalism when dealing with clients and staff.
• Provide analytical analyze answer, resolve all inbound customer services-related inquires, regarding patient accounts including but not limited to statements explanation of benefits, estate, write off, bad debt collection information input insurance information by way of registration ROI authorization, maintain protected health information
• Manage collection of payments, adjustments, coordinate patients refunds with credit balance department. Provide itemized bills when requested and very insurance claim edit and benefits.
• Collect credit card payment, balance and batching.
• Verify and update insurance information, file claims,appeals and coordination of benefits.
• Post customer service adjustments, write off, contractual adjustments, and charge correction.
• Validate charges, and codes are correct and request for medical review and audit when necessary.
• Discuss and establish payment plan for extended term of payment provide financial assistance application.
• Collaborate and coordinate with insurance companies, employee workers compensation, liability insurance and attorney inquires.
• Support escalated calls as needed to resolve patients concerns in a timely manner.
• Identify and assist department inefficiencies and workload.
• Document information in EPIC Hyland, utilize One Note, On Base, track and record (CRM) to record and resolve patients concerns. Tracked customer service cases and updated service software with customer information.
• Adhere to all HIPPA and confidentially guidelines.
• Access with the patient portal, My Chart, login issues, access with online login and message inquires.
• Delivered exceptional customer service to every customer by leveraging extensive knowledge of products perform all other customer services billing duties etc. and services and creating welcoming, positive experiences.
• Tracked customer service cases and updated service software with customer information.
• Established and checked coding procedures, monitored reports and updated internal files.

• Resolved customer complaints using established follow-up procedures.
• Receptionist duties in a busy Urgent, Primary Care Office, collect co-payments, and batch balance.
• Assisted patients with completing necessary paperwork and forms to provide healthcare facilities with essential information to bill for services.
• Schedule appointments, register patients demography and insurance information in IDX system and EPIC, document patients information in electronic medical system All Scripts, faxing scanning, sorting mail.
• Train new hires on Epic system for scheduling appointment, registration, referral and authorization.
• Supported patients with necessary care during end-of-life phases by coordinating of care.
• Worked with patients to schedule tests and procedures.

• Financial Counselor/Admission Patient Access Registration and Authorization for Admission. Perform all patients admitting processes including demographic, insurance information, for billing, and collection of payment.
• Radiology Authorization Specialist- Obtain Precertification for all radiology procedures: Cat Scan, MRI, Angiography, Nuclear Medicine, and or all radiology procedures that require authorization. Verify insurance benefits, precertification billing CPT code prior to appointment. Document system for billing, Follow-up on denial request appeal for non authorization in a timely manner. Communicate with ordering provider and insurance company.
• Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
• Super User for EPIC System. Train and supervise colleagues, new staff on work related duties as well as new Urgent Care facility, Fast Care, and Women Infusion Center.
• Conducted regular audits to ensure compliance with regulatory standards and insurance company policies related to the approval process.
• Utilize various insurance web-portal Passport, One Source insurance system, Microsoft Word Power Point Access and Excel.

Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.

• Entered client details and notes into system for interdepartmental access and review.
• Deployed automated system tracking and skip tracing to locate hard-to-find, re-located customers.
• Collaborated with the billing department to resolve discrepancies in account balances and ensure accurate invoicing for customers.
• Researched billing errors and discrepancies to initiate corrective action.

• Managed multiple tasks and met time-sensitive deadlines.
• Serve as Committee to MIS forum, liaison between computer programming staff and radiology staff for upgrade from paper to computer. Enter data to Esprit processing system.
• Demonstrated strong multitasking abilities while managing numerous tasks simultaneously under tight deadlines.
• Compiled information from files and research to satisfy information requests.

• Supported office efficiency by performing clerical tasks such as data entry, photocopying, scanning, and faxing documents.
• Answered phone promptly and directed incoming calls to correct offices.
• Kept reception area clean and neat to give visitors positive first impression.
• Provided administrative support to staff members by handling correspondence, filing documents, and managing office supplies inventory.
• Rotate to related areas within the department, Record film file room, Ultrasound, Nuclear Medicine , transcription and Radiologist office,
• Conduct department scheduling, pre-op, filing and prepare xray for surgery.