Benefits Specialist

Jacqueline M.

Smith

**** ******* ***** *******, ** 30360 404-***-****

***********@*****.***

Skilled, results-driven Professional with over 15 years of experience in

Client Support, Medicare, Medicaid, Managed Care billing and Collections.

Proven ability to work in fast pace environments productively, service

excellence and quality improvement.

TECHNICAL SKILLS

AND SKILLS SUMMARY

. Microsoft Office Suite

. SSI billing system

. American Health Tech / LTC

. First Coast Services Organization (EDI)

. Trail Blazer Health (EDI)

. Care Tracker Resource Systems

. HBO Star/ HBO Financials

. Palmetto GBA (EDI)

. NC Tracks

. eProvider Solutions

. National Government Services (EDI)

. Ability & Ability Ease

. Simple LTC

. Emdeon

. Wisconsin Physician Services (EDI)

PROFESSIONAL EXPERIENCE

2014-2015

Pruitt Health

Norcross, GA

Medicare Billing and Collection Specialist

. Responsible for Medicare claims submission and corrections to

Wisconsin Physician Services via Emdeon.

. Research outstanding account balances for appropriate adjudication.

. HIQA and Common Working File

. Daily posting of Medicare Remittance Advices

. Work closely with Financial Counselors and Regional Financial

Counselors of various Skilled Nursing Facilities regarding payer

sources and accurate claim reporting.

2012-2014

Camden Place Health and Rehab, LLC

Greensboro, NC

Business Office Manager

. Responsible for submission and correction of Medicare claims and

Private pay accounts for 135 bed facility with 95% accuracy in

Medicare billing.

. Assisted with Medicaid and Managed Care claims for processing and

corrections.

. Met with resident and families regarding payment options and assisted

with insurance issues.

. Worked closely with MDS Coordinators confirming accurate payor

sources.

. Liaison with various vendors regarding payables and collections.

. Managed Patient Trust account.

. Provided financial reports to all pertinent parties including the

owner.

. Successfully closed financials at the end of each month.

. Responsible for cleanup of old accounts and corrected setup to reflect

accurate accounting.

2000-2011

LaVie Administrative Services dba Coastal Administrative Services (formerly

Centennial Healthcare)

Atlanta, Georgia

Applications Support Technician

. Provided customer service, application and SSI billing (UB04/837/835)

support to 160 facilities staff via phone, VNC and remote assistance.

. Provided customer service support to 100+ Senior Nursing Facilities

and Long Term Care facilities to the transfer of 837 claims to

corporate office and fiscal intermediaries for immediate processing.

. Trained team members on SSI Billing system.

. Tested the functional validation and usability of future application

releases.

. Assisted in providing working specs and updates to software, which

resulted in increased accuracy and timeliness of "clean claims" to

fiscal intermediaries.

. Developed processes to ensure claims handled accurately and

efficiently.

. Provided ongoing training of billing protocol to facility and field

personnel.

. Assisted with managing production releases and configurations with

AHT/LTC application updates in database.

. Client support analyst for Care Tracker/MDS Director Application.

. Created video tutorials for Care Tracker/MDS Director Application.

. Manually updated and corrected resident profile and data issues in

Care Tracker from AHT Application.

. Provided tutorials to new hires for user access and navigation of Care

Tracker/MDS Director Application.

. Assisted in troubleshooting of various reports in the Care Tracker/MDS

Director Application.

. Provided operational support and hands-on implementation testing for

SSI billing (UB-5010).

. Tracked all support issues in tracking system TrackIT.

. Maintained a working knowledge of all basic industry standards as they

relate to software applications

Human Resources Benefits Coordinator

. Administered facility and corporate enrollment for audits for eligible

employees and new hires.

. Administer FMLA, COBRA and invoiced payments.

. Liaison with various vendors regarding employees status changes,

eligibility and demographics.

. Interacted daily via emails and direct incoming calls pertaining to

benefits, disbursement and claim inquiries.

. Managed the facility Compliance/employee relations tracking.

Procurement Coordinator

. Managed direct procurement process and vendor formularies for multiple

regions encompassing 35 nursing facilities.

. Researched and specialized in non standard formularies from various

vendors.

. Provided customer service support, established and communicated

departmental and facility standards, capital expenditure procedures,

and ensured compliance and adoption.

. Reviewed vendor contracts, and eliminated wasteful spending by

leveraging communication and negotiation skills.

. Built and maintained rapport with more than a dozen national

suppliers.

Accounts Receivable Analyst

. Analyzed information received from 80 nursing facilities to verify

charge codes for accurate recording of financial revenue, and ensure

compliant Medicare and Medicaid billing.

. Liaison between the facility and corporate offices, providing support

and training to the facilities as needed.

. Processed Medicare and Medicaid claims received from the facilities

through the SSI system or directly to the Intermediaries.

1998-1999

National Data Corporation

Norcross, Georgia

Senior Reimbursement Specialist

. As Team Lead, worked with management and staff to develop

comprehensive training programs that increased productivity while

boosting staff morale and involvement.

. Handled accounts with multiple defaulted payment arrangements.

Analyzed activity on "agency referral" accounts and determined if

probability of resolution exists.

Education

Fort Valley State College University- Fort Valley, GA 1980-1983 Food and

Nutrition Education Major

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