Tiambia Smith
Houston,TX
Summary
Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Utilization Management Specialist
Elevance Health
09.2019 - Current
- Performed admission reviews based for medical necessity based upon diagnosis and procedure code specification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Facilitated communication between providers and payers, resolving authorization issues promptly.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Performed prior authorization review of services requiring notification.
- Reviewed medical records meticulously to verify appropriate level-of-care determinations, reducing potential overpayments or denials.
- Applied effective time management techniques to meet tight deadlines.
- Assigns accurate ICD-10-CM/ICD-10-PCS codes.
Insurance Claims Analyst
Elevance Health
11.2016 - 09.2019
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Generated, posted and attached information to claim files.
- Stayed current on industry trends and changes in insurance policies, enabling accurate interpretation of coverage details for various plans.
- Paid or denied medical claims based upon established claims processing criteria.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Calculated adjustments, premiums and refunds.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Customer Service Representative
Elevance Health
10.2014 - 11.2019
- Investigated and resolved member inquiries and complaints quickly.
- Responded to member requests for member benefits, services, and eligibility.
- Promoted superior experience by addressing member concerns, demonstrating empathy, and resolving problems swiftly.
- Promptly responded to inquiries and requests from prospective members.
- Delivered prompt service to prioritize member needs.
- Actively listened to member, handled concerns quickly and escalated major issues to supervisor.
Education
Certified Coding Associate - Medical Billing And Coding
DeVry University
Villa Park, IL11.2023
Skills
- HIPAA Compliance
- Insurance Verification
- Healthcare regulations
- Outpatient Care
- Inpatient Care
- Medicaid knowledge
- Medical Coding
- HCPC/ICD-10-CM/ICD-10-PCS
- EMR / EHR
Certification
- CCA - Certified Coding Associate
Timeline
Utilization Management Specialist
Elevance Health
09.2019 - Current
Insurance Claims Analyst
Elevance Health
11.2016 - 09.2019
Customer Service Representative
Elevance Health
10.2014 - 11.2019
Certified Coding Associate - Medical Billing And Coding
DeVry University
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