SUMMER SMITH
Arlington,TX
Summary
8 years of managerial experience in overseeing and assisting specialized operations. Seeking to leverage my technical, professional, and interpersonal expertise to grow in a new role at your company.
Overview
15
15
years of professional experience
Work History
Benefit Verification Specialist
Amgen
03.2023 - Current
- Maintained 100% accuracy on all quality audits for two years in a row.
- Tasked with working on dedicated sites, ensuring compliance and efficiency in all processes.
- Selected for several special projects, including the SOB Review Team and SME position.
- Provided exceptional customer service by addressing patient concerns regarding coverage and out-of-pocket expenses.
- Managed high-volume caseloads while maintaining strict deadlines for completing benefit verifications and authorizations.
- Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
- Improved patient satisfaction by accurately verifying benefits and providing timely responses to inquiries.
- Initiating benefits verification by reviewing patient data and insurance material, including identifying missing information and following up with points of contact to resolve information gaps.
- Verifying benefits for each assigned patient case and detailing any requirements for reimbursement, including copays, coinsurance, utilization management requirements, qualifications/restrictions, and prior authorization requirements.
- As applicable, initiating subsequent actions.
- Monitoring potential delays or pended cases and identifying/documenting lessons learned and potential leading practices resulting in shorter processing times or higher success rates.
- Supporting new initiatives and process improvement activities as required (e.g., end-user testing of new system features and supporting technology).
- Understanding and adhering to government regulations and company policies.
- Maintaining positive rapport with internal and external customers through effective communication and active listening.
On-Premise Market Manager
Slicker Beverage Insights
05.2021 - 02.2023
- Works with vendors and senior management to develop and implement new menus and specials
- Remotely manages the Beverage team to include efficient staffing, employee development and training, performance management and policy enforcement daily
- Creates and enforces proper policies and procedures for Manager comps and voids
- Works with vendors and senior management to develop and implement new event specials
- Communicates and maintains daily direct communication with Assistant Beverage Managers to ensure clear and accurate information on Promotions as well as setting the bar for business expectations
- Management of brand building efforts and volume driving activities in the on-premise and promotional and PR/Events
- Builds strong relationships with key on-premise accounts, distributor management and distributor salesmen
- Social Media Management
Insurance Administrator
Midtown/Ramic Medical Imaging
02.2014 - 05.2021
- Manages operations at a central insurance verification department of several employees
- Assures that insurance verification and necessary pre-verification is obtained prior to service for 3 high-volume centers, grossing $18 million a year
- Responsible for the interviewing, hiring and training of insurance team members
- Creates and designed insurance verification and authorization process for all sites
- Assists inexperienced staff on proper procedures and protocols used with in the office
- Implements and maintains all Training Resource Manuals and tools utilized for training
- Provide additional / ongoing training and recommendations on an as needed basis
- Obtains prior authorizations from insurance companies with appropriate medical credentials in a timely manner
Insurance Verification Specialist
Midtown/Ramic Medical Imaging
02.2011 - 01.2014
- Gathered patient insurance details and initiated insurance pre-authorizations.
- Supported providers in utilization, authorization, and referrals.
- Verified member coverage for studies.
- Used Microsoft Word and Excel for daily documentation.
- Scheduled and confirmed patient appointments.
- Interviewed patients for documentation.
- Ordered supplies and managed records.
- Compiled medical charts and reports.
Office Care Coordinator
Texas Hospice
10.2010 - 01.2011
- Maintained medical records and files.
- Routed messages and documents to staff.
- Sent correspondence and records via mail, email, and fax.
- Handled phone calls, messages, and errands.
- Copied data and records using photocopiers.
- Sorted information by various criteria.
- Scanned materials for filing.
- Ordered supplies and managed related records.
Office Assistant Coordinator
Texas Family Medicine
01.2010 - 10.2010
- Assigned identification codes for filing.
- Inspected files for accuracy and damage.
- Updated file records with additional data.
- Stored materials according to classification.
- Greeted and directed visitors.
- Answered and routed phone calls.
- Scheduled diagnostic and consultation appointments.
- Utilized ICD-9 coding with Medisoft billing software.
Education
High School -
Southwest High School
Bachelor of Science - Computer Science
TCC
Fort Worth, TX03-2028
Skills
- Self-motivated
- Enthusiastic
- Detail oriented
- Great organizational skills
- Multi-tasking
- Managing details
- Organizing efficiently
- Organizing effectively under pressure
- Knowledge of HIPAA compliance
- Knowledge of medical terminology
- Knowledge of CMS-1500 billing forms
- Knowledge of ICD-10
- Knowledge of EPIC
- Knowledge of CPT codes
- Employee training and development
- Advanced clerical skills
- Spreadsheet management
- PC literate
- Proficient in Microsoft Office
- Word processing
- Fast-paced environment
Timeline
Benefit Verification Specialist
Amgen
03.2023 - Current
On-Premise Market Manager
Slicker Beverage Insights
05.2021 - 02.2023
Insurance Administrator
Midtown/Ramic Medical Imaging
02.2014 - 05.2021
Insurance Verification Specialist
Midtown/Ramic Medical Imaging
02.2011 - 01.2014
Office Care Coordinator
Texas Hospice
10.2010 - 01.2011
Office Assistant Coordinator
Texas Family Medicine
01.2010 - 10.2010
High School -
Southwest High School
Bachelor of Science - Computer Science
TCC
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