Summary
Overview
Work History
Education
Skills
Timeline
Generic

Tiara Smith

Garland,TX

Summary

Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Motivated professional offering proficiency in data entry combined with strong mathematical and analytical thinking skills. Personable team player with exceptional customer service abilities. Fast learner and committed to continuous, self-directed learning.

Overview

10
10
years of professional experience

Work History

Medical Claims Analyst

Mutual Of Omaha
10.2020 - 04.2024
  • Served as expert resource for colleagues on medical coding systems such as ICD-10, CPT, and HCPCS Level II coding conventions.
  • Improved customer satisfaction by resolving complex medical claims in a timely and professional manner.
  • Ensured accurate payments by meticulously reviewing medical records, invoices, and supporting documentation.
  • Determined complex claim benefits based on medical records and contract language, ensuring timely decisions for both payment and denial.
  • Analyzed and processed complex claims, communicated effectively with external and internal customers, and finalized claims while explaining handling procedures.
  • Provided effective customer service through various channels, using expanded knowledge and resources to resolve inquiries and perform service recovery techniques.
  • Met/exceeded departmental standards for attendance, productivity, and quality, while actively participating in daily management, contributing insights for process improvements, and supporting service delivery enhancements.
  • Engaged in self-development, stayed informed about industry changes, and adhered to company processes and regulations while building and maintaining effective working relationships.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures, and HIPAA regulations.
  • Verified patient insurance coverage and benefits for medical claims.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Managed large volume of medical claims on daily basis.

Data Analyst

Comcast Corporation
06.2019 - 10.2020
  • Produced monthly reports using advanced Excel spreadsheet functions.
  • Utilized data visualization tools to effectively communicate business insights.
  • Created various Excel documents to assist with pulling metrics data and presenting information to stakeholders for concise explanations of best placement for needed resources.
  • Participated in requirements meetings to understand business needs
  • Improved decision-making processes with accurate data analysis and visualization techniques.
  • Enter appropriate data into computer program
  • Produced and maintained data reports and alerted management of inconsistencies or issues.
  • Performed database queries to assist with analysis and reported issues when appropriate and necessary.
  • Verified data entries for accuracy and completeness.
  • Undertook special projects; provided periodic and consistent information to management for each phase of the assigned project
  • Performed audits of own work and or that of others to ensure conformance with established procedures
  • Maintained up-to-date knowledge of industry trends and advancements in data analytics, enhancing the adaptability of solutions provided.

Accounts Receivable Collections Specialist

UnitedHealth Group
10.2014 - 06.2019
  • Corresponded with insurance companies to resolve payment delays, requests for additional information or to discuss denied treatment coverage.
  • Faciliated past due invoice payments by sending bill reminders and contacting clients.
  • Verified discrepancies to resolve vendor billing issues.
  • Followed up overdue payments and payment plans from clients to establish good cash flow.
  • Utilized Microsoft Excel, QuickBooks and Oracle software to manage invoices and payments.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Evaluated EOB's for the need for an appeal for reduced payment or CPT denial.
  • Ensured daily productivity standards were met and daily EOB's, reports and appeal files were cleared within 48 hours of receipt (allowing for weekends and holidays).
  • Monitored and communicated errors generated by other departments, communicating trends while maintaining active knowledge of ICD-9 and ICD-10 coding.

Education

Bachelor of Arts - Business Administration

University of Phoenix - Online

High School Diploma -

Hamilton High School
Memphis, TN
05.2009

Skills

  • Claims Processing Proficiency
  • HIPAA Compliance Understanding
  • Medical Terminology Familiarity
  • Training and mentoring
  • Healthcare regulations knowledge
  • Medical terms and procedure knowledge
  • Insurance Verification
  • Accounts Payable
  • Quality Assurance
  • Coupa
  • Peoplesoft ERM
  • WMPlus
  • Electronic Customer Relationship Management (CRM)
  • Insurance Policies Knowledge
  • Active Listening
  • Documentation skills
  • Data accuracy
  • Fasty Typing Speed
  • Document processing
  • Database Management
  • Auto Insurance Claim Handling
  • SAP Ariba
  • ShipStation
  • Microsoft Office (Excel, Word, PowerPoint, Outlook)
  • Oracle
  • SAP
  • Medical Terminology Familiarity
  • Claims Processing Proficiency
  • Customer Service
  • Medical record review
  • Insurance Verification
  • Quality assurance checks
  • Data Entry
  • Accuracy and Attention to Detail
  • Word Processing
  • Data Processing

Timeline

Medical Claims Analyst

Mutual Of Omaha
10.2020 - 04.2024

Data Analyst

Comcast Corporation
06.2019 - 10.2020

Accounts Receivable Collections Specialist

UnitedHealth Group
10.2014 - 06.2019

Bachelor of Arts - Business Administration

University of Phoenix - Online

High School Diploma -

Hamilton High School
Tiara Smith