Summary
Overview
Work History
Education
Skills
Timeline
Generic

Laura Smith

Hendersonville,TN

Summary

With over 20 years of customer service expertise and a specialized focus in TennCare Medicaid, I excel in complex eligibility determinations and appeals, achieving a 100% quality score in 2024. Trained by the State of Tennessee, proficiency in Microsoft Applications and exceptional problem-solving skills were honed at Automated Health Systems Inc., ensuring compliance and high-level service.

Overview

8
8
years of professional experience

Work History

Customer Service Representative II

Automated Health Systems Inc.
Nashville, TN
07.2021 - Current
  • Currently a Fully Remote Level 2 Customer Service Representative for Automated Health Systems Contract with State of Tennessee - Division of TennCare.
  • Handles Priority TennCare Cases and Eligibility Appeals
  • Daily Completion of Additional Information- Appeal tasks, Review for Eligibility tasks, Authorization tasks, Verifications, Case Changes, Reopening/Reinstating Cases, and New Applications via Member Portal, Member Portal Phone Application, Fax, Mail, and Federally Facilitated Marketplace
  • Handles Cases included but not limited to Caretaker Relative/MAGI, CoverKids Pregnant Woman, Nursing Facility, Hospital Care, Home and Community Based Services/CHOICES, and Medicare Savings Program Cases
  • Resolves Member and Worker Escalations

Provides Monitoring, Coaching, and Rollout of New Operations in Tennessee Eligibility Determination System, TennCare Member Portal, and Document Processing

  • Safely handles SSA and other Protected Health Information on a daily basis
  • Abides by all laws and regulations regarding Protected Health Information and other sensitive information
  • Continues to excel at necessary State training to remain credentialed with the State of Tennessee - Division of TennCare
  • Maintains Quality Scores of 100% Consecutively for the entirety of 2024


Customer Service Representative

KEPRO
Nashville, TN
02.2019 - 07.2021
  • Maintained In-Office then fully Remote Customer Service Position for KEPRO's Contract with the State of Tennessee - Division of TennCare
  • Transferred and maintained position when TennCare Contract was transferred to Automated Health Systems
  • Received and completed TennCare Applications and Additional Information/Verifications task on a daily basis, via Phone, Fax, Member Portal, TennCare Member Phone App, Hospitals, Nursing Facilities, and the Department of Health
  • Abided by all laws and regulations regarding Members' Protected Health Information
  • Maintained and excelled at necessary State training to remain credentialed with the State of Tennessee - Division of TennCare

Customer Service Representative

Tennessee 811
Nashville, TN
07.2017 - 02.2019
  • Successfully placed safe and accurate dig requests for the purpose of safe excavation, for all 95 counties in Tennessee
  • Provided the best possible communication, education, and notification services to prevent danger to the people and underground utilities across the state of Tennessee
  • Notified Tennessee utility companies of any request to excavate, while providing accurate details and description of area where excavator intended to dig
  • Extended great day-to-day customer services via phone and email
  • Trained and assisted new employees in the proper procedures and policies for placing Locate Requests with callers
  • Maintained daily sub-contracted employment to After-Hours Locate Request Inbound Call Centers for the states of Alabama, Mississippi, and Arkansas, while leading the Tennessee Call Center

Education

Photojournalism And English Literature

Middle Tennessee State University
Murfreesboro, TN

High School Diploma -

Beech High School
Hendersonville, TN
05-2004

Skills

  • 6 Years TennCare Medicaid Experience
  • 20 Years Customer Service Experience
  • Trained by State of Tennessee - Division of TennCare
  • Existing Successful Career involving TennCare Medicaid Eligibility
  • Proficiency in all Microsoft Applications

Timeline

Customer Service Representative II

Automated Health Systems Inc.
07.2021 - Current

Customer Service Representative

KEPRO
02.2019 - 07.2021

Customer Service Representative

Tennessee 811
07.2017 - 02.2019

Photojournalism And English Literature

Middle Tennessee State University

High School Diploma -

Beech High School
Laura Smith