Cleonice “Cleo” Smith

ad4im1@r.postjobfree.com

972-***-****

SENIOR MEDICAL ACCOUNT REP

Extensive experience in the healthcare and insurance industries. Competent areas of office administration and executive support. Proven ability to communicate well with

diverse groups and individuals. Efficient skills and ability to manage multiple tasks. Versatile with experience in both physician and hospital claims. Knowledge of medical

terminology, insurance contract rates such as PPO, HMO, POS, U&C. Insurance compliance with EOB as well as determining refunds. Receiving customer service calls

from the patient, providers, insurance companies and the State Insurance Commission.

Successfully resolving 80% of difficult claims.

STRONG SKILLS

Written and phone appeals. Strong problem-solving. Routinely document and prepare audit trail of communications. Contacting departments to resolve a problem. Work special projects off an Excel sheet. Creating spreadsheets. Making outbound calls to resolve problems/issues. Can access several internet programs. HIPPA Compliance.

EXPERIENCE

Integrated Medical Management 7/6/2020 - 2/19/2021 Special Projects Collection

Plano, Texas

Assisting with obtaining accurate demographics upon request

Answering phones and responding to patient and business needs

Completing various billing and accounts receivables functions including charges, posting, claim appeals

Addressing patient billing questions

Data Entry on personal HIPPA information

Inform Diagnostics

Las Colinas, Texas 5/22/17 – 11/13/19 Senior Rev Cycle Rep

Senior Rep working Blue Cross Blue Shield daily correspondence

Processed 25-100 pieces of mail daily from various states for BCBS

Correspondence included denied appeals, wrong billing payor, incorrect coding

Each correspondence from BCBS is resolved by researching, adjusting off, correcting

Determining how to resolve the claim

DFW Area 2015 till 2017

Old-Aged Senior Rep Specialist

Working temporary jobs for the following four healthcare providers to help solve and clean up their old-aged accounts by vigorously researching the primary reason of denial, short pay or no response from the first time billing till the last correspondence. The results driven have produced a large increase of correct reimbursement payments due to the provider. The four clients that I have worked for under contracting are as follows on page 2,

Pg 2

Continue from DFW area

Texas Scottish Rite Children Hospital 9/16/16 thru 4/1/17 Past-Due Acct Rep

Dallas, Texas

Working on special project to close old accounts.

Determining the reason as to why account has an unexplainable balance

Billing patient if it is a legal patient balance

Determining if a contractual has been posted over or under adjusted

Interpret and adjudicates claims in compliance with the eob

Christus Health 3/7/16 thru 7/1/16 Medical Collections

Irving, Texas

Primary carriers were Miscellaneous Insurances

Followed up on several smaller insurance companies or hard to contact insurance carriers for reason of nonpayment

Rebilling to correct insurance plan or home plan

Verifying correct network pricing per contract with provider

First Choice ER 12/7/15 thru 1/29/16 Aged Medical A/R

Lewisville, Texas

Central business office was closing

My duties were to resolve balances on all miscellaneous insurance carriers

Health Tech Management Service 9/15/14 thru 8/21/15 TPA Senior Rep Plano, Tx

Working third party billing for two California heart hospital

Resolving claim by tracking down insurance eobs

Outside vendor for medical provider accounts

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