SORANYI SMILLIE
New Haven,CT
Summary
Detail-oriented healthcare professional with 8+ years of experience in claims resolution, insurance benefit analysis, billing support, and patient account management. Expertise in researching claim discrepancies, supporting appeals, verifying eligibility, and collaborating with providers and processing teams to ensure accurate reimbursement. Adept at simplifying complex insurance information for members and preventing claim denials through accurate documentation and problem-solving. Seeking to contribute strong analytical, service, and insurance knowledge as a Medical Claims Specialist.
Overview
13
13
years of professional experience
Work History
Member Advocate
UnitedHealthcare
10.2022 - Current
- - Handle 20–100 inbound inquiries daily, resolving complex issues related to benefits, eligibility, claims, spending accounts, and correspondence.
- - Investigate claims discrepancies, coordinating with internal processing teams to ensure accurate resolution and explaining outcomes clearly using EOBs.
- - Support Medicare appeals, prior authorizations, and predetermination requests by guiding members through required documentation and status updates.
- - Educate members on benefit utilization, cost-saving options, pharmacy benefits, and digital tools to enhance self-sufficiency.
- - Coordinate across providers and internal specialists to resolve escalated issues and prevent delays in care or payment.
- - Recognized for exceptional performance and selected for special projects aimed at improving member satisfaction and retention.
Hartford HealthCare – St. Vincent’s Medical Center
10.2021 - 12.2022
- - Verified insurance, completed prior authorizations, and ensured accurate registration to reduce claim rejections and billing errors.
- - Performed billing functions including charge entry, copay collection, and daily financial reconciliation.
- - Resolved claim holds caused by registration or coding errors, collaborating with clinical and billing teams to recover delayed revenue.
- - Ensured HIPAA-compliant handling of patient demographics, chart preparation, and record management.
- - Provided clear financial guidance to patients regarding costs, insurance coverage, and payment expectations.
Office Manager / Medical Assistant
Shalva Clinic
12.2020 - 10.2021
- - Managed scheduling, referrals, insurance verification, and medical records with strict HIPAA compliance.
- - Assisted with billing, financial discussions, and documentation accuracy to support smooth claims processing.
- - Prepared treatment rooms, supported providers with patient education, and coordinated clinical workflows.
- - Oversaw medical inventory and supplements to maintain uninterrupted clinic operations.
- - Improved patient satisfaction by addressing billing questions, workflow gaps, and front desk processes.
Office Manager & Personal Assistant
Bavier Design LLC
01.2017 - 01.2020
- - Managed office operations, AP/AR, scheduling, and vendor coordination.
Assistant & Sales Representative
Oz Moving & Storage
01.2014 - 01.2017
- - Generated $30K+ monthly sales; handled billing, inventory coordination, and customer follow-up.
Telemarketer / Entertainment Staff
Forever Young Adult Daycare
01.2013 - 01.2014
- - Supported engagement, outreach calls, and intake screenings.
Sales Representative
MHG Consulting
01.2013
- - Developed leads, educated clients, and closed sales.
Education
Bachelor’s Degree - Nursing
Goodwin University
Hartford, CTAssociate in Applied Science - Paralegal Studies
Berkeley College
New York, NYSkills
- Claims & Billing
- - Claims research & discrepancy resolution
- - CMS, Medicare, Commercial Insurance
- - Eligibility & benefits verification
- - Prior authorizations & predeterminations
- - Medicare appeals support
- - CPT & ICD coding (Beginner)
- - EOB interpretation
- - Charge entry & copay reconciliation
- Technical Systems
- - Maestro, GPS, EDW
- - Epic
- - Genesys
- - Microsoft Office (Advanced)
- - QuickBooks
- Administrative & Interpersonal
- - High-volume customer support
- - HIPAA compliance
- - Documentation accuracy
- - Provider & department coordination
- - Problem-solving & de-escalation
- - Bilingual member communication
Languages
Languages: English & Spanish (Fluent)
Timeline
Member Advocate
UnitedHealthcare
10.2022 - Current
Hartford HealthCare – St. Vincent’s Medical Center
10.2021 - 12.2022
Office Manager / Medical Assistant
Shalva Clinic
12.2020 - 10.2021
Office Manager & Personal Assistant
Bavier Design LLC
01.2017 - 01.2020
Assistant & Sales Representative
Oz Moving & Storage
01.2014 - 01.2017
Telemarketer / Entertainment Staff
Forever Young Adult Daycare
01.2013 - 01.2014
Sales Representative
MHG Consulting
01.2013
Associate in Applied Science - Paralegal Studies
Berkeley College
Bachelor’s Degree - Nursing
Goodwin University