Shirley Smith1524 NW Rutland RoadMount Juliet, TN 37122615-913-7603shirley.ann1012@gmail.comProfessional Background:Responsible Medical Assistant with excellent communication skills demonstrated by 4 years of experience in healthcare and life insurance. At least 4 years of experience in the field or in a related area. Familiar with a variety of the field's concepts, practices, and procedures. Relies on experience and judgment to plan and accomplish goals. Performs a variety of complicated tasks. May direct and lead the work of others. Proficient with Microsoft office programs and the use of database programs. I am highly motivated, reliable and committed to professional standards. I am a very organized and detail oriented problem solver with demonstrated communication and conflict resolution skills in customer service and administrative support. I have the ability to work successfully as a leader as well as part of a team. I can establish effective priorities amongst competing requirements. I have a diversified product and industry knowledgeSkill Highlights:Policy and program developmentAreas of clinical experience include: Patient Training, Medical Billing and Coding, Infection Control, Urinalysis, Pharmacology, EKGs. OB/GYN experience. Medical Assisting.Proficiency with computerized charting, People person with a great bedside manner, Ability to manage priorities and meet deadlines, Alphabetical/Numerical filing, Medical clinical procedures, Medical transcription, Obtaining/charting vital signs, Prompt customer service, Appeals filing and processing, Professional Experience:Computer Science Corporation December 2015 to currentSenior Assistant Claims Examiner IIProcesses, pays claims and provides assistance to customers and administrative staff, Member notification letters

Comply with state laws, policy and company procedures

Assist claimants, providers and clients with problems or questions regarding their claims and/or policies

Prepare and print drafts for payment of claims and verify that payments have been made

Denies, settles, or authorizes payments to routine property/casualty claims based on coverage

Responsibilities also include corresponding with policyholders, claimants, witnesses, attorneys, etc. to gather important information to support contested claims in court.

Prepares report of findings of an investigation.

Typically reports to a manager or head of a unit/department.

Broadpath SolutionsMay 2013 to December 2014Claims AdjustorQuickly and accurately analyze claims and make reconsideration decisions on Medicare appeals.Handled all accounts payable and receivableReviewed patients claims, adjusting claims for corrections on pay due to in corrections in systems, verified PHI of the patientsWorked on multiple applications at the same time in FACETSEnsure accurate and prompt adjudication resultsProvde and maintain in-depth notation per Client standards/requests

Redetermination Appeal Specialist1.Quickly and accurately analyze claims and make reconsideration decisions on Medicare appeals

2.Reviews appeal requests, Medical Review (MR) and Zone Program Integrity Contracts (ZPIC ) documentation to determine if all required information has been submitted.

3.Working together as team away from a supervisor, handling analytical cases with on daily level.

4. Verifying all Centers for Medicare and Medicaid Services (CMS) rules and regulations for Medicare Part B appeals using Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).

CGS-Bluc Cross Blue Shield of SCAugust 2012 to May 2013CSR ADVOCATE/APPEALS SPECIALIST1.Quickly and accurately analyze claims and make reconsideration decisions on Medicare appeals.

2.Reviews appeal requests, Medical Review (MR) and Zone Program Integrity Contracts (ZPIC) documentation to determine if all required information has been submitted.

3.Handles numerous appeals for Diabetic, Urological, Tracheostomy and other Ostomy CPAP, Nebulizers and other respiratory assist devices daily.

4.Verifying all Centers for Medicare and Medicaid Services (CMS) rules and regulations for Medicare Durable Medical Equipment (DME) using Local Coverage Determinations (LCDs) and Policy Article guidelines.

Windsor Medicare Extra November 2011 to July 2012CSR II1.Answered incoming calls, greeted all visitors and production teams, handled patients and provider calls and claims

2.Handled all accounts payable and receivable, worked in system FACETS, looking up PHI information.

3.Communicating the determination in a clearly written letter and ensuring the letter is sent to the appropriate departments.

4.Worked independently in a high volume call center

5.Implemented a process and procedures handbook for numerous positions

6.Created multiple spreadsheets, to more effectively manage daily tasks

Asurion May 2010 to November 2010CSR1.Worked independently in a high volume call center

2.Implemented a process and procedures handbook for numerous positions

3.Created multiple spreadsheets, to more effectively manage daily tasks

4.Maintained documentation of calls, sales and all shipments

Genesis Woman Center August 2007-August 2009Medical Assistant1.Demonstrated flexibility in a highly dynamic work environment connected with the patient record location and confidential documents throughout the medical center.

2.Facilitated interdepartmental problem resolution, and customer service

3.Processed large volumes of work with speed and accuracy.

4.Member of a collaborative team that transferred over 6 million patient histories to chartless records.

Software Knowledge & EducationMicrosoft Word, Microsoft Excel, Outlook, Medical Terminology Course, FACETS, VMS, CLEARVIEW, CMA, Master, Cyber life, AWD.Mutual Respect Course, Dealing with Difficult People Course, VMS, Six week course training for DME MAC Customer Service position, Two week up-training course, CGS Compliance training, CGS HIPPA training, Ensured charting accuracy through precise documentationDelivered compassionate care that exceeded hospital requirements, successfully provided quality care to number of patients in healthcare environment, Prepared regular charts on patient's health related history, medication restrictions and allergies, Properly disposed of daily biohazard waste in compliance with federal and local regulations, Educated patients in regards to office policies, medical procedure steps, recovery measures and medication instructions.Education and Training:Bethel UniversityCurrently attending for Bachelors Degree in Business and minoring in Early Childhood EducationRemington College-Medical Assistant

Phlebotomy, Patient Training, Medical Billing and Coding, Infection Control, Urinalysis, Pharmacology, EKG's, venipuncture, Tracheotomy, Wound Dressing, ICD-9, Infection Control.