Front Office Customer Care

AKILAH J SMITH

(H) 404-***-**** **** Arnolds Mill Overpass, Douglasville, GA 30135 *****.******@*****.***

PROFESSIONAL SUMMARY

Experienced healthcare reimbursement professional with specialized skills in revenue cycle management, third-party payer function, front-end process implementation, effective communication and team-focused leadership.

SPECIALIZED SKILLS

Effective manager and analyst of revenue cycle process improvement and implementation

Creative, resourceful approach to “big-picture” problem-solving

Expert-level knowledge of Medicare/CMS and Worker’s compensation/billing processes

Expert-level knowledge of Evaluation & Management coding and medical record requirements

Expert-level knowledge of coding of specialist physician services and third-party billing

CAREER PATH

02-2015 – current, Georgia Perinatal Consultants, LLC – Atlanta, GA

Provider Reimbursement Coordinator

Direct management and analysis of complete third-party billing process, from clean claim to appeal-level reimbursement

Focus on resolving major issues affecting third-party reimbursement (i.e., accuracy of sub-specialty contracting/credentialing with all payers, fee scheduling management and updating)

Building of successful relationships with regional payer representatives, for faster, more efficient resolution of ongoing reimbursement issues.

Implementation of prior authorization and referral procedures for front-line staff, to include keeping abreast of procedural changes with periodic communication and training of staff.

Keeping abreast of changing industry best practices and coding, to ensure accurate and fair reimbursement of providers.

Quantifiable results achieved through identification of simplified, more automated front-end care authorization systems

Successful and timely resolution to a substantial reimbursement issue triggered by ICD-10 implementation, through productive partnerships fostered with regional payer representative.

Successful management/monitoring of a new charge capture/automated coding and billing system with timely resolution of unforeseen issues

06-2011 – 02-2015, Atlanta Sports Medicine and Orthopaedic Center and Surgery Center – Atlanta, GA

Revenue Cycle Manager

Supervise, evaluate functions of 2 Reimbursement Specialists, 3 Benefits Coordinators; analyzing process efficiency, implementing and/or revamping steps where necessary, utilizing data built from weekly/monthly/quarterly reports.

Oversee the complete reimbursement process – from patient demographics processing to denial management and the appeals process

Report building/analysis to pinpoint current and/or potential problems with coding functions, patient data/EMR, etc.

Manage claims EDI process; ensuring ‘clean claim’ submission, rejected claim management, through clearinghouse system

Maintaining provider network participation; contract credentialing/re-credential and facility privileges

Achieved quantifiable results of increased revenue through efficient process management of necessary systems, for 7 consecutive quarters.

Designed effective benefits verification/pre-billing system; which, alone has improved quarterly collections by a consistent 15-24%

Reimbursement Specialist

Worked w/work-comp claims adjusters to obtain outpatient surgery pre-authorizations, post-op care benefits coordination through the utilization review process

Obtained private carrier pre-auths and pre-determinations for inpatient/outpatient surgery; coordination of patient responsibility budgeting and payment plans

Coded surgical procedure claims from operative reports, referencing NCCI edits, and other resources for accurate initial coding; claim corrections, re-submissions

First and escalated level appeals processing, payment review for appropriate fee schedule-level reimbursement; additional payment requests; patient collections

Other duties: working A/R aging reports; collections reporting/spreadsheet building; ensuring patient record/data-CMS compliance; coding/compliance issues reporting; facilitating Medicare/CMS audits

Initiated standard, voluntary pre-determination review request process for outpatient procedures deemed ‘experimental/investigational’ by insurance carriers; allowing more effective grounds for later appeals, based on medical necessity.

03/2007 – 04/2011, All Medical Personnel Agency - Atlanta, GA

03/2010 – 04/2011, Pediatric Orthopaedic Associates

Front Office Assistant, Billing

Daily assessment of charge entries to ensure accurate coding/linking, code/modifier assignment of office and surgical procedures from dictated operative and clinic notes, global periods pertaining to surgery and fracture care

Re-examination of denied claims for resubmission to payors, third-party billing, payor and patient collections.

03/2008 – 03/2010, Atlanta Diabetes Associates – Atlanta, GA

Front Office Coordinator

Leadership role of front office staff of 6, in a private Endocrinology practice

Oversaw efficient flow of check-in, check-out, switchboard, scheduling, insurance verification, referrals, charge-entry, payment posting

Managed daily electronic submission of correctly coded claims; oversaw reimbursement process, regarding denials due to coding, medical necessity, medical records, etc.

Assisted in credentialing/recredentialing of providers/extenders with all payer products/networks.

Use of strong customer care skills to diffuse escalated patient situations, to end-result satisfaction.

09/2005 - 3/2008, Assurant Group - Duluth, GA

Customer Care Rep 2

Fielding property insurance-related calls on behalf of various mortgage companies to maintain customer data

Educating customers regarding lender-placed insurance processes

Fielding escalated calls, initiating follow-up on issues, through to resolution

Verification of insurance documents using Proforms software

12/2000 - 06/2005, Cardiology Associates - Cleveland, OH

Medical Administrative Assistant

Scheduled inpatient/outpatient procedures, office appointments; surgical pre-authorizations.

Initiated end-of-day close procedures; patient encounter forms, charge entry, patient payments, daily deposits

Provider schedule maintenance for speaking engagements, conferences, etc.

EDUCATION

Ursuline College, Pepper Pike, OH - Bachelor of Science (Business)

Professional Development Courses: Society of Maternal-Fetal Medicine National Conference Training – (2016), AAPC Coding Workshops (2007 – current), Essentials of the Reimbursement Process - (2008), Third-Party Billing - (2007)

References Available Upon Request

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