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  • Tammy Smith

    Expertise in Customer Service

    Tammy Ilo Smith
    2724 West McLellan Blvd Unit 105
    Phoenix, Az. 85017
    480-776-9990
    Email address: tis4evr@yahoo.com


    Career Profile
    I have an excellent work record in comprehensive administrative procedures, emphasizing operational functions in the Medical Field and Call Center environments. I am highly knowledgeable in all fields of Medical Health Plans. I am proficient in Call Center practices and processes. My expertise has provided me with superb Customer Service skills in evaluating, organizing, and communicating. All of these qualities coupled with my years of experience and education qualify me for a variety of opportunities.

    Employment

    Select Medical Corporation /Select Physical Therapy - Phoenix, AZ (Dec 2009- present)
    Patient Services Specialist
    - Responsible for the daily Front Office operations of an individual outpatient Physical Therapy office.
    - Responsible for very busy multiple phone lines in accessing, processing, and scheduling multi daily patient referrals via phone, fax and walk-in.
    - Responsible for all patient Insurance verifications by way of obtaining, applying and processing Insurance authorizations while utilizing and updating ICD-9 and CPT coding for accurate billing processes.
    - Responsible for collection of and processing co-pays and payments of patient supplies and billing (AR).
    - Responsible for admission chart preps and continued maintenance of all patient Medical Records and requests while always assuring PHI and HIPAA guidelines are followed in each instance.
    - Responsible for ordering, maintaining, processing, and payments are performed for office operational needs while staying within budgetary guidelines.

    Aetna Health Insurance aka Schaller Anderson Healthcare Inc- Phoenix, AZ (April 2005-Nov 2009)
    Supervisor- Member Services and Prior Authorizations
    - Responsible for hiring, training, coaching, mentoring, scheduling and reporting of performance for 14 FTE and 8 PTE of the MS and PA After -Hours Call Center and Data Entry staff for Commercial, Medicaid and Medicare lines of business.
    - Responsible for the supervision of all functions and services of the departments while ensuring all metric service levels were maintained and met meeting contractual guidelines.
    - Responsible for monitoring and reporting quality processes of staff interacting with our customers via phone, fax and internet
    - Responsible for researching and resolving escalated and complex claim, benefit, PA, COB, and pharmacy issues of a members Health Plan.
    - Responsible for the development and maintenance of training materials, desktops, policies and procedures.
    - Responsible for being the departmental liaison as an Aetna Benefit representative interacting with existing and potential clients regarding plans and programs for requested services. I did this while traveling as needed, delivering group presentations or individual meetings.


    Radiology Medical Group/ Radiology Service Partners- San Diego, Ca (Nov 2000-April 2005)
    Supervisor - Accounts Receivable and Prior Authorizations (2002-2005)
    Front Desk Associate (2000-2002)
    - Responsible for hiring, training, coaching, mentoring, scheduling and performance evaluations of 6 FTE AR/ Prior Authorization representatives and 9 FTE-Clinic Receptionists.
    - Responsible for the training programs of such staff to ensure knowledge and quality standards were being obtained and met.
    - Responsible for maintaining and reporting daily, weekly and monthly billing statistics as well as staffing production reports both individually and as a whole clinic.
    - Responsible for assuring all proper medical ICD-9 and CPT codes were being properly addressed and utilized for correct billing processes
    - Responsible for supervising the development and implementations of scheduling outpatient and inpatient radiology services, verifications of medical insurances, obtain Prior authorizations as needed, collection and accountability of co pays and deductibles, and applying the AR posting's of charges and payments.
    - Performed inbound and outbound calls from patients and healthcare providers regarding patient medical orders, services needing provided, and procedures performed.
    - Provided Medical Record upkeep as well as daily distributions of paper and hard copy films of Radiology exams performed.
    - Effectively developed, performed and followed a work priority plan to ensure day to day activities and heavy work loads were fulfilled.


    Education
    Mount Marty College, Watertown S.D 1982-1983; Lake Area V-Tech, Watertown S.D 1984; Lamson Jr. College, Phoenix Az. 1987; Grossmont College, San Diego Ca. 1994-1995, University of Phoenix online

    References Available Upon Request

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