Jacqueline L. Smith16863 GREENLAWN HILLS CT, CHARLOTTE, NC 28213

TELEPHONE: 704-804-8442 / EMAIL: GENUSJLS519@GMAIL.COM

CAREER PROFILE A seasoned highly dynamic, organized, detailed oriented focused

professional billing specialist with successful record handling several clients and complicated assignments. Dedicated to maintaining strict patient confidentiality.

More than 15 years’ of successful experience in customer service and support with recognized strengths in account maintenance, problem-solving and trouble-shooting, sales staff support, and planning/implementing proactive procedures.

SYNOPSIS OF ACHIEVEMENTS IDX/Centricity-PM/WF/Free View/Gateway/Starr/EMR/Prime-Suite

Greenway Increased customer retention by 20 % from 72% to 92%/Reactivated key

accounts utilizing persuasion and mediation skills / Received Peak Performer, Spotlights, Balanced Performer and Perfect Attendance Awards

Special Expertise in cleaning up Receivable over 120 days Responsible for planning and coordinating education and training

guidelines for staff QA account accuracy consistent at 97%-100% Monthly productivity (90 accounts per day on average was met)

COMPUTER SKILLS Excel Spreadsheets Word Insurance websites NC Tracks (Medicaid Website) Suntrust Lockbox Retina Injectible Copay Assistance Programs: Eylea4U, PANF, CDF EMR/Medflow/Ducuware

EDUCATION

Central Piedmont Community College, Charlotte, NC Associate of Applied Science

Certified Coder-current student -Insurance Reimbursement Class January 2015-May 2015: Completed -Advance Coding Class: January 2016

EMPLOYMENT

February 2015-PresentCredentialing SpecialistIndependent Contractor, JLS Billing Charlotte, NC

Responsible for credentialing 10 Physical Therapy Clinics; with a total of 21 locations.

Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations.

Create and carry out various credentialing processes in relation to Physical Therapist and Clinical Facilities. Ensure all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws.

Process applications and reappointment paperwork, checking for full completeness and accuracy.

Consistency in collecting and processing significant amounts of verification and accreditation information.

Maintain and update accurate databases for both practitioners and facilities. These databases include pertinent education, training, experience, and licensure content.

Prepare and store all pertinent documents and information in spreadsheet on One Drive and ebridge; for regular auditing, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.

July 2014-PresentInsurance Reimbursement SpecialistCharlotte Eye Ear Nose Throat Associates, Charlotte, NC

Manage patient insurance/health insurance, insurance health claims by performing duties within the scope of the policy and procedures defined by Charlotte Eye Ear Nose and Throat Associates.

Filing & Follow up of all insurance claims according to department protocol, document and adjust patient account information in the practice management software.

Posting all insurance checks and/or charges and adjusting write-off’s as required

Correspondence as required for insurance companies requesting additional information.

Runs hard copy claims as well as file electronic claims. Provide patient education regarding insurance claims Train new employees on obtaining information from various CEENTA software

as well as insurance websites Train new employees on proper procedure for adjusting/voiding claims via

electronic filing and paper. Created CEENTA Business Office Manual guideline for BCBS in-house

procedure for working an open A/R claim/Denied Claim/Recoupment Claim Oversee claim issues with SC physicians’ open A/R accounts Worked extensive spread sheets concerning open A/R over 90 days Created spread sheets as needed for outstanding projects

Retina Insurance SpecialistCharlotte Eye Ear Nose Throat Associates, Charlotte, NC

File Avastin Claims to BCBS with invoice attached File VA Claims with auth and medical records for processing of payment Fax claims to Drug assistance Programs (CDF; Eylea4u, PANF) for patients. Verified patient had available funds in drug program (which covers balance

after insurance) Researched, update and follow up on spreadsheets for 4 Physicians who

administer injections to patients.

Post payments from Drug Programs to patient accounts Enroll approved patients in drug assistance Payment Programs. Worked Accounts Receivable queues for open accounts of 120 days and older Worked Retina Denial queues Worked daily correspondence Verified coverage, obtained prior Authorization, referrals for Retina injectable

patients Called Insurance for update and claims denials and payments Process corrected claims via electronically and paper Familiarity with Retina Drug Codes: Avastin & Eylea

April 2014-July 2014Insurance Reimbursement Specialist

Lake Norman Regional Medical Center- Mooresville, NC Maintains knowledge of all facets of insurance claim filling, requirements and

regulations. Maintain work queue in Claim IQ so that accounts are not delinquent Identifies delayed insurance claims. Maintains an active file of authorizations, UB 04 claim forms, and reports to

file with insurance claims. Process, reviews, and makes corrections by Remote Entry System. Attends in-service and required meetings as scheduled. Researches information to complete any re-billing process. Maintains established department policies, procedures and objectives. Assists responsibility for all insurance claims being researched. Practices the standards of Service for the Health System. Performs other duties as assigned by supervisor.

October 2008 – February 2014A/R Researcher IIMcKesson/Formerly MED3000 - Charlotte, NC

Locate, compile, and report denial trend Insure office practices are in compliance with HIPAA regulations Post and reconcile insurance and patient payments. Research and resolve

incorrect payments, EOB rejections, and other issues with outstanding accounts.

Follow up on insurance and patient aging. Re-submit insurance claims as necessary. Knowledgeable in timely filing restrictions

Created Excel spreadsheets of open accounts with status of various End of Month Reports

Back up help for charge entry and payment posting departments during End of Month

Department Trainer

July 2006 – August 2008A/R Collector Southeast Anesthesiology Consultants - Charlotte, NC

Handled all open A/R reports for Medicare NC/SC; and commercial insurances Post Payments Responsible for Lox Box, bank deposits and month-end balancing Responsible for daily and month-end balancing Responsible for meeting quarterly bonus goals

November 2002 –September 2005Team LeaderArmanti Financial Services – Bloomfield, NJ

Oversee Medicare Billing team of 7 employees Trained New employees

Handled all outpatient specialty billing (Hemodialysis/Physical/Occupational/Radiation/Hyperbaric Therapy)

October 2000- September 2002Medicare/Medicaid BillerBrookdale Hospital- Brooklyn, NY

Process hospital claims for Specialty billing Post Payments Followed up on outstanding claims using spread sheets

November 1998-November 1999Accounts Receivable Coordinator:Epilepsy Foundation of Long Island, New York

Process all billing for day treatment program, intern care facilities and clinics. Input daily log of case from insurance, patients, fundraisers and clients. Updated and follow-up any change to clients SSA/SSI income. Prepared financial reports, G/L reports and journal entries Completed occasional house audits and performed other duties as assigned

by Assistant Controller

REFERENCES AVAILABLE UPON REQUEST