Kendra

Smith

404-***-****

adnhj6@r.postjobfree.com

Call Center Pro with Inbound & Outbound Call Handling Experience

Customer Service Revenue Cycle Management Reimbursement and HUB Support Home Care Manager Web support

Service oriented professional with over 20 years of diverse customer centric experience, including 10 years within Healthcare Revenue Cycle Management and 5 years as a Conscientious Home Care Manager. Highly experienced Reimbursement and Market Access Consultant, responsible for specialty pharmacy benefit verifications, prior authorization, and coverage determinations; presenting and facilitating healthcare reimbursement options to providers, patients and pharmacies. Electronically bill Workman’s Comp, Commercial, Medicare, and Medicaid claims. Home care management: ensuring the appropriate care is provided to patients through effective staff management, creating individual care plans, implementing safety policies and procedures.

Skills

Outstanding ability to interpret policies and procedures and communicate orally and written effectively

Remarkable ability to make decisions and exercise good judgment in a complex environment. Strong communication and interpersonal skills

Technical skills. Web support and SME on Pharmaceutical provider portal and E-Services (Training and demonstration)

Proficient in MS Office suite and health care documentation systems (EPIC, Sorian, Med Easy, ICRS, Relay, Shiftboard, HPF, STAR, CERNER, Waystar

Fully knowledgeable with state regulation codes and, HIPPA guidelines and policies. Expertise in Market Research and Trending, Payer Surveillance

Fully proficient with medical terms, procedures, and physician documentation guidelines. Certified medical terminology with diverse medical billing, ICD-9/ICD-10 coding and claim and denial assistance.

Digital Communication via email, live chat, Android and ISO

Immense ability to demonstrate self-motivation, superior organization and time management skills

Customer service orientation

Patience and diplomacy. Professionalism and telephone etiquette

Benefits verifications, prior authorizations or PA Support, Formulary Exception. Buy and Bill and hospital infusion, office injectable and self-injectable and oral therapy experience.

Professional Career

AUGUST 2020-MAY 2021

Patient Financial Rep & Insurance Follow Up / Wellstreet by Piedmont, Newnan, GA

Awards Results: Maintained 98% monthly on quality audits scores.

Client Services: Responsible for the accounts receivable of 17 different Wellstreet Urgent Care clients totaling $5 million in charges each month, including credentialing, denial management and third party follow up. Worked with the clearinghouse and the payers to ensure all claims were processed and received by the insurance companies in a timely manner. Reduced clearinghouse denials from 39% "bomb" rate to 15% in a 6-month period of time.

Insurance follow up on aging accounts. Processed and retrieved medical records from facility or by using HPF application.

Process Improvement: Improved department collaboration by merging front and back end processes increased point of service by 300 percent. Segmentation resulted in knowledge gaps amongst RCM staff

Team Development: Effectively communicate the effectiveness diversity and inclusion by organizing team building activities and simulated exercises between leadership and peers.

FEBUARY 2019 – SEPTEMBER 2020

Independent Customer Service Agent / Liveops, Remote, USA

Award Results: Received 95% customer satisfaction survey to date. Promoted within 2 months after hiring to Tier 2 agent to assist train seasonal agents for the 2019 Tax Year.

Client Services: In a remote home environment, assisted 50 or more customers daily with Intuit Turbo Tax products, navigate program functionality, troubleshoot software and installation issues. Supported 45 new agents via Slack with level 2 technical calls and escalation queue. Responsible for making informative and resourceful decisions.

Team Development: Initiated HEAT Campaign and incentives to all new agents to help increase customer satisfaction and survey participation. Raised customer satisfaction scores by 30% in 4th quarter.

NOVEMBER 2017-SEPTEMBER 2019

Prior Authorization & Insurance Follow Up / Fresenius Medical Care, Kennesaw, GA

Awards Results: Maintained 98% monthly on quality audits scores.

Client Services: Reduced company write-off report by 70% by verifying and initiating pre-certification, retrospective, and out of network authorizations for dialysis treatment and specialty medication in a timely manner. Billed commercial claims electronically using Relay Health. Resolved payer discrepancies. Conducted insurance follow up on aging accounts. Processed and retrieved medical records from facility or by using HPF application.

Process Improvement: Developed and created an extensive and detailed payer research tool including specific prior authorization requirements for Medicare/Medicaid and commercial polices.

Team Development: Effectively communicate the effectiveness diversity and inclusion by organizing team building activities and simulated exercises between leadership and peers.

AUGUST 2015 – OCTOBER 2017

Personal Care Home Manager / OnMyWay Cornerstone, Marietta, GA

Responsible for generating 95% new business, sourcing and interviewing healthcare aids for personal care duties. Developed and implemented eco-friendly process improvements or Standards of Operations. Responsible for collection, aging, establishing write-off standards and claim denial management. Decreased billing cycle turnaround time by 40% by implementing automation into the process.

Established care and safety plans for new and established clients. Ensured availability of professional services for patients, introduce them to services and affiliated resources. Maintained accuracy of state regulations, guidelines and PHI and facility records

Electronically billed Medicare and Medicaid claims using Centricity Group Mgmt. Printed paper claims to bill out to payers. Performed documentation of accounts follow ups. Resolved payor discrepancies, denials and appeals. Posted payments and adjustments.

JANUARY 2010 – JULY 2015

Senior Reimbursement Counselor / AmeriSourceBergen, Charlotte, NC

Recognized by leadership and peers as a reimbursement and Medicare/Medicaid subject matter expert.

Progressed to managing high profile National Accounts team and Mid-Atlantic region, combined totaling 2.2 million in revenue from a high cost specialty drug launch, surpassing the departmental goals by 6%.

Assisted with new hire training, staff development and simulated activities. Coordinated product and regional lunch and learn meetings among field reps, leadership, and peers on a monthly basis.

Developed and created a payer surveillance resource that compartmentalized market trends, payer drug polices, prior auth requirements, and access options for new specialty drug.

Served on a team of lead web support agents to assist with the provider portal e-services. Ability to demonstrate functionality features and navigate level 2 technical issues in a timely manner.

AUGUST 2008 – JANUARY 2010

Benefit Verification Specialist / AmeriSourceBergen, Charlotte, NC

Executing the organization’s objectives in providing excellent customer experience for clients’ patient assistance programs to patients and healthcare providers. Using a consulting approach assisting patients and their healthcare providers to complete the enrollment process. Serving as a point of contact for patients and healthcare providers in resolving issues efficiently and effectively.

Assisted with developing and implementing eco-friendly process improvements or standards of operations, {SOP}.

NOVEMEBER 2004-JULY 2008

Intake Coordinator / Kaiser Permanente, Atlanta, GA

Reviewed benefits and eligibility for services requiring authorizations or review by the Medical Director.

Developed and organized departmental fundraisers for the March of Dimes Foundation and assisted in planning and developing the community health fairs.

Education and Certifications

FEBUARY 2020-CURRENT

Stayer University / Atlanta, GA

Bachelor of Science Business Management

JUNE 2015-JUNE 2015

American Red Cross / Atlanta, GA

Certified CPR and First Aid

AUGUST 2015-OCTOBER 2015

Atlanta Area Tech/ Atlanta, GA

Medical Terminology Certification

JANUARY 1998-NOVEMBER 1998

Georgia Medical Institute / College Park, GA

Registered Medical Assistant Certification

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