Summary
Overview
Work History
Education
Skills
Timeline
Generic

Sylvia Smith

Graysville

Summary

Results-driven Workers Comp Claims Specialist with expertise in medical claims analysis and insurance regulations. Achieved significant improvements in operational efficiency at Upstream Rehabilitation by identifying trends in rejected claims and managing successful appeals. Strong customer service skills and precise data entry enhance proficiency in claims software systems.

Overview

18
18
years of professional experience

Work History

Workers Comp Claims Specialist

Upstream Rehabilitation
Birmingham
11.2019 - Current
  • Reviewed and analyzed insurance claims to ensure accuracy and payment eligibility.
  • Identified trends in rejected claims to reveal potential system errors.
  • Assisted with appeals for denied claims, collaborating with insurance companies.
  • Utilized claims software systems to effectively manage and track claim progress.
  • Maintained up-to-date knowledge of insurance laws and regulations for billing compliance.
  • RainTree, Jopari, WayStar, Fuse, LaserFiche

Front Desk Medical Receptionist

Sequatchie Valley Eye Care
Dunlap
02.2011 - 05.2018
  • Communicated accurate details about promotions, customer programs, and products to enhance service quality.
  • Managed cash register operations efficiently by scanning items and processing payments.
  • Documented patient information and insurance data for seamless appointment scheduling and payment processing for over 3,000 patients.
  • Ensured strict compliance with HIPAA guidelines to protect patient privacy.
  • Executed general office duties, such as answering phones, routing calls, and greeting customers.
  • OfficeMate, Greenway, Microsoft Office Suite.

Executive Secretary

Sequatchie County Government
Dunlap
06.2007 - 02.2011
  • Administered Tennessee Tire Grant and coordinated quarterly community outreach events for TN Tire and TN Litter Grants.
  • Developed tracking spreadsheets in MS Excel, achieving 17% reduction in overall spending.
  • Provided time-sensitive information to all elected county officials to enhance decision-making.
  • Processed legal documents including civil summons, levies, liens, and arrest warrants.
  • Filed all Workman's Comp Claims for county employees efficiently.
  • Utilized Outlook and Microsoft Office Suite to streamline administrative tasks.

Education

High School Diploma -

Sequatchie County High
Dunlap, TN
05-2001

Skills

  • 10 years of customer service
  • 7 years of workers' compensation expertise
  • 5 years of claims management
  • Microsoft Office proficiency
  • Time management skills
  • Appeals management
  • Claims investigation
  • Time management skills
  • Appeals management
  • Regulatory compliance

Timeline

Workers Comp Claims Specialist

Upstream Rehabilitation
11.2019 - Current

Front Desk Medical Receptionist

Sequatchie Valley Eye Care
02.2011 - 05.2018

Executive Secretary

Sequatchie County Government
06.2007 - 02.2011

High School Diploma -

Sequatchie County High
Sylvia Smith