Tameil Smith
Woodstock
Summary
Analytical and detail-oriented Revenue Cycle Claims Billing Analyst with over 7 years of experience in healthcare billing and claims processing. Proven expertise in optimizing revenue cycles and ensuring compliance with regulatory standards. Seeking to leverage analytical skills and extensive knowledge in digital analytics to contribute to effective revenue management at CenterWell Llome Health.
Skilled Resolution Specialist with background in resolving complex customer issues efficiently. Strengths include strong problem-solving abilities, effective communication skills, and capacity to maintain high customer satisfaction rates. Notable impact made in previous roles includes improved customer retention through responsive service solutions and proactive conflict resolution strategies.
Resourceful Resolution Specialist known for high productivity and efficient task completion. Skilled in conflict resolution, customer service strategies, and negotiation techniques. Excel at communication, problem-solving, and adaptability, ensuring successful resolutions that meet both company and client needs.
Overview
14
14
years of professional experience
2
2
years of post-secondary education
1
1
Certification
Work History
Claims Settlement & Payment Resolution Specialist
Zelis Healthcare
Atlanta
02.2018 - 03.2026
- Reviewed out-of-network claims for accuracy and appropriateness.
- Communicated with providers on settlements and payment decisions.
- Negotiated reimbursements per plan guidelines and market rates.
- Investigated billing issues and validated documentation.
- Collaborated with teams to resolve payment disputes.
- Ensured compliance with payer policies and payment methods.
- Tracked case activity and maintained settlement records.
- Supported payment integrity by identifying billing patterns.
- Analyzed patient accounts to identify discrepancies and ensure accurate processing.
- Determined extent of liability by reviewing evidence, laws and administrative or judicial precedents.
- Prepared for hearings by reviewing laws and regulations.
- Readied settlement paperwork for signature.
- Educated disputants on laws, regulations and procedures applying to cases and potential legal roadblocks for proposed solutions.
- Conducted studies of appeals procedures to confirm adherence to legal requirements while facilitating disposition of cases.
Healthcare Arbitration & Payment
HaloMD
Atlanta
02.2020 - 04.2021
- Managed federal NSA IDR cases from start to finish.
- Interpreted EODs, LICFAs, and payer correspondence for arbitration eligibility.
- Drafted payor responses and arguments citing CMS guidelines.
- Identified underpayment trends and reported to leadership.
- Improved turnaround by prioritizing disputes and enhancing workflows.
- Collaborated with legal, providers, and payers for out-of-network reimbursements.
- Ensured compliance with federal arbitration timelines and standards.
- Used dispute tracking systems for quality assurance and audit readiness.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Worked with cross-functional teams to achieve goals.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Utilized advanced technical skills and expertise to troubleshoot complex problems and implement solutions.
- Utilized various software and tools to streamline processes and optimize performance.
- Achieved cost-savings by developing functional solutions to problems.
- Completed routine maintenance and repair.
- Conducted system analysis and testing to identify and resolve technical issues or inefficiencies.
Reimbursement Compliance & Policy Analyst
Healthcare Compliance Operations
Atlanta
05.2019 - 02.2021
- Interpreted federal billing regulations and No Surprises Act requirements.
- Assessed payer reimbursement methods and regulatory compliance.
- Prepared documentation for reimbursement disputes.
- Identified inconsistencies in insurers' payment policies.
- Ensured documentation readiness for audits.
- Collaborated with stakeholders for compliant billing practices.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Collaborated with fellow team members to manage large volume of claims.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
- Organized information by using spreadsheets, databases or word processing applications.
- Corresponded with insured or agent to obtain information or inform of account status or changes.
Revenue Cycle Manager
WellCare Health Plans
Woodstock
02.2018 - 02.2020
- Conducted comprehensive data analysis aimed at optimizing the revenue cycle management process for the organization. This involved assessing claim submissions and identifying patterns and trends that contributed to claim denials. By implementing targeted strategies based on the analytical findings, I successfully increased claim approval rates by 20%, thereby significantly improving cash flow and overall revenue for the company. This achievement not only highlights my analytical capabilities but also demonstrates my commitment to enhancing operational efficiencies within the revenue cycle.
- Cultivated strong relationships with clients to enhance satisfaction and retention.
- Facilitated onboarding processes for new clients, ensuring smooth transitions.
- Managed client inquiries, providing timely and effective support solutions.
- Collaborated with cross-functional teams to address client needs and feedback.
- Developed training materials to educate clients on product features and benefits.
- Analyzed client data to identify trends and improve service delivery strategies.
- Coordinated regular check-ins with clients to assess satisfaction levels and needs.
- Developed and maintained relationships with clients to ensure customer satisfaction.
- Communicated well with clients through phone calls and online meetings to maintain satisfaction and keep parties current with changing environment.
- Conducted research to determine top prospective clients and continually cultivated sales pipeline.
- Provided customers with technical support and guidance on product usage.
- Recruited and trained professionals employees and provided evaluations with feedback to cultivate highly talented team.
- Assisted in onboarding new customers, ensuring a smooth transition into the platform.
- Built reports tracking key performance indicators and presented insights to stakeholders.
- Trained and mentored new team members to promote productivity, accuracy, and friendly customer service.
Healthcare Operations & Workflow Analyst
Healthcare Operations
Woodstock
05.2018 - 09.2019
- Conducted a comprehensive analysis of operational workflows to identify inefficiencies that were adversely affecting reimbursement timelines.
- Designed and implemented standardized response templates and decision trees, significantly enhancing processing efficiency.
- Collaborated with cross-functional teams to refine and optimize dispute resolution procedures.
- Developed and documented Standard Operating Procedures (SOPs) and provided training for team members on process enhancements.
- Facilitated automation readiness by articulating business requirements and establishing logic rules.
- Led leadership in the evaluation and reporting of operational performance metrics.
- Internal Process Improvement
- Analyzed workflow processes to identify areas for improvement.
- Developed documentation for standard operating procedures and best practices.
- Gathered requirements from stakeholders to define business needs.
- Created test plans for new processes prior to implementation.
- Conducted user interviews and surveys to gather feedback on existing processes.
- Designed, developed, implemented and maintained automated workflows.
- Supported users by providing guidance on how best to use the organization's workflow system.
- Ensured compliance with regulatory requirements relating to the organization's workflow system.
- Maintained up-to-date knowledge of industry trends in order processing technology.
- Defined metrics for measuring success of workflow initiatives.
- Provided training on new process implementations or changes to existing processes.
- Managed project deadlines and provided team leadership.
- Increased overall efficiency annually.
- Monitored adherence to project timelines, company standards, and budget requirements for professionals.
- Coordinated project plans and reviewed with stakeholders and clients to ensure alignment of expectations.
Revenue Cycle Analyst - Denials & Reimbursement
Northside Hospital
Atlanta
01.2012 - 06.2019
- Conducted thorough investigations of insurance denials across commercial, Medicare, and Medicaid payers.
- Resolved billing discrepancies related to modifiers, timely filing, and coordination of benefits (COB) issues.
- Reviewed claims and rectified payment errors to optimize reimbursement outcomes.
- Analyzed trends in denial rates and enacted corrective measures to address underlying issues.
- Engaged with payers to recover revenue lost due to inaccurate reductions.
- Managed a high volume of accounts receivable utilizing Epic and various payer portals.
- Provided training to staff on billing accuracy and adherence to payer requirements.
- Collaborated with departments to resolve billing discrepancies effectively.
- Monitored claim submissions to ensure compliance with regulations and policies.
- Assisted in training staff on revenue cycle best practices and procedures.
- Reviewed accounts receivable reports to track outstanding payments regularly.
- Supported audits by providing necessary documentation and reports promptly.
- Developed process documentation for revenue cycle workflows and protocols.
- Engaged with patients to explain billing statements and payment options clearly.
- Participated in revenue cycle processes, working to maximize profitability and increase revenue.
- Evaluated system changes impacting revenue cycle operations including workflow optimization opportunities.
- Identified areas of opportunity within the organization's revenue cycle processes through data analysis or benchmarking studies.
- Implemented best practices related to billing processes while ensuring compliance with all regulatory requirements.
- Created reports for management regarding payment trends, denials, rejections, and other performance metrics.
- Assisted with the implementation of new systems or procedures related to revenue cycle activities.
- Extracted and defined record and file data and compared it to business operations information to better understand revenue cycles.
Accounts Receivable & Medical Billing Specialist
Omega Healthcare Management Services
02.2018 - 02.2018
- Oversaw the management of high-volume medical claims for commercial, Medicare, and Medicaid payers.
- Addressed and resolved claims denials related to coding discrepancies, modifiers, eligibility issues, and deadlines for filing.
- Conducted follow-ups with insurance carriers to secure outstanding reimbursements.
- Rectified claim edits and resubmitted claims to mitigate potential revenue loss.
- Analyzed Explanation of Benefits (EOB) to detect underpayments and initiate the appeals process.
- Ensured adherence to productivity and quality metrics within designated accounts receivable (AR) work queues.
- Collaborated with healthcare providers and internal teams to facilitate accurate claim submissions.
- Documented account actions in accordance with payer and regulatory standards.
Education
MBA - Marketing
American Public University Systems
Charleston, WV 08.2019 - 06.2020
Bachelor of Science - Marketing
Health Information Management
Atlanta, Ga 07.2016 - 02.2018
Skills
- Revenue Cycle Claims Processing
- Healthcare Billing Analytical Skills
- Digital Analytics Compliance Data Analysis
- Customer Centric
- Financial Reporting
- Client Interaction
- Payment resolution
- Regulatory compliance
- Denial management
- Revenue cycle management
- Stakeholder collaboration
- Data analysis
- Effective communication
- Problem Solving
- Attention to Detail
- Claims dispute Resolution
- Arbitration specialist coordinator
- Independent Dispute Resolution (IDR)
- No Surprises Act (NSA)
- Dispute Resolution
- Analytical Thinking
- Technical Proficiency
- Out-of-Network Reimbursement
- Payment Integrity
- Healthcare Arbitration
- Payor Disputes & Appeals
Certification
- Certified Revenue Cycle Management Specialist
- Certified Healthcare Financial Professional
Projects
Claims Optimization Project: Spearheaded a project to streamline the claims process, reducing processing time by 30%.
Keywords
- Revenue Cycle Claims Processing
- Healthcare Billing
- Analytical Skills
- Digital Analytics
- Compliance
- Data Analysis
- Remote Work
- Financial Reporting
- Client Interaction
- Problem Solving
- Attention to Detail
- Claims Dispute Resolution
- Arbitration Specialist Coordinator
- Independent Dispute Resolution (IDR)
- No Surprises Act (NSA)
- Dispute Resolution
- Analytical Thinking
- Technical Proficiency
- Out-of-Network Reimbursement
- Payment Integrity
- Healthcare Arbitration
- Payor Disputes & Appeals
Timeline
Healthcare Arbitration & Payment
HaloMD
02.2020 - 04.2021
MBA - Marketing
American Public University Systems
08.2019 - 06.2020
Reimbursement Compliance & Policy Analyst
Healthcare Compliance Operations
05.2019 - 02.2021
Healthcare Operations & Workflow Analyst
Healthcare Operations
05.2018 - 09.2019
Claims Settlement & Payment Resolution Specialist
Zelis Healthcare
02.2018 - 03.2026
Revenue Cycle Manager
WellCare Health Plans
02.2018 - 02.2020
Accounts Receivable & Medical Billing Specialist
Omega Healthcare Management Services
02.2018 - 02.2018
Bachelor of Science - Marketing
Health Information Management
07.2016 - 02.2018
Revenue Cycle Analyst - Denials & Reimbursement
Northside Hospital
01.2012 - 06.2019