KELLIE SMITH
Rockville
Summary
Results-driven Pharmaceutical and Healthcare Professional with over four years of experience in patient access, reimbursement, and payer engagement. Expert in identifying customer needs and overcoming access barriers, while effectively communicating complex healthcare information. Leverages quality metrics and customer insights to drive performance and inform strategic decisions in highly regulated environments.
Overview
6
6
years of professional experience
Work History
Outpatient Authorization & Reimbursement Coordinator
ADVENTIST HEALTHCARE REHABILITATION HOSPITAL
10.2025 - Current
- Submit outpatient prior authorization requests through payer portals, ensuring required clinical and billing documentation is complete and accurate.
- Manage authorization workflows from initial submission through determination, maintaining timely follow-up with insurance carriers to prevent treatment delays and appointment cancellations.
- Verify patient eligibility, insurance coverage, benefits, and financial responsibilities with commercial and government payers.
- Review clinical documentation and apply appropriate CPT and billing codes to support accurate prior authorization submissions.
- Researched denied claims and authorization requests, identified denial reasons, gathered supporting documentation, and coordinated resolution strategies to enhance approval rates.
- Coordinated peer-to-peer reviews between providers and insurance medical directors, facilitating discussions that supported authorization approvals.
- Prepare and submit appeals for denied services in accordance with payer requirements and organizational guidelines.
- Collaborate with providers, clinical teams, patients, and insurance representatives to communicate authorization and reimbursement updates.
- Proactively identified authorization barriers and implemented corrective actions to enhance revenue cycle efficiency and ensure appropriate reimbursement for high-cost outpatient services.
Lead Patient Access Specialist
ASTRAZENECA PHARMACEUTICALS
Gaithersburg, MD
06.2022 - 04.2025
- Improved appointment scheduling efficiency through implementation and utilization of an online booking process.
- Enhanced patient record accuracy by enforcing data-entry standards and conducting regular reviews for completeness.
- Improved insurance verification accuracy through routine audits, quality reviews, and staff training.
- Streamlined appointment scheduling by implementing and utilizing an online booking process.
- Facilitated revenue collection by ensuring timely billing follow-up and coordinating payment plans for financially challenged patients.
- Educated patients regarding healthcare responsibilities, privacy practices, available resources, and program support throughout their healthcare journey.
- Supported staff productivity by managing schedules, assigning responsibilities based on employee skill sets, and optimizing daily workflow.
Administrative / Receptionist
SIMMONDS, MARTIN & HELMBRECHT
Takoma Park, MD
04.2021 - 01.2022
- Served as a primary point of contact for prospective clients, providing professional and responsive customer service.
- Managed high call volumes, accurately gathering client information and coordinating appointments to ensure seamless service delivery.
- Scheduled appointments based on availability and client needs.
- Answered customer questions and resolved scheduling and service-related concerns.
- Resolved client inquiries and scheduling concerns, enhancing customer satisfaction and service efficiency.
- Supported patient registration and insurance verification processes.
- Collected copayments and patient payments, ensuring accurate transaction records to support financial processes.
- Maintained confidentiality of sensitive information in accordance with HIPAA requirements.
Program Specialist
COVANCE
03.2021 - 04.2021
- Conducted needs assessments and analyzed program data to identify service gaps and opportunities for improvement.
- Used data analysis and key performance indicators to evaluate program effectiveness and support process improvements.
- Verified insurance eligibility and benefits prior to procedures and appointments to support uninterrupted patient care.
- Conducted needs assessments and analyzed program data, identifying service gaps and recommending improvements.
- Evaluated program performance, identified operational deficiencies, and proposed strategies for enhanced outcomes.
- Analyzed data and key performance indicators to assess program effectiveness and support targeted process improvements.
- Maintained compliance with HIPAA requirements while handling confidential patient and insurance information.
Education
High School Diploma -
Saint Croix Central High School
Hammond, WI05-2013
Skills
- Prior authorization
- Insurance verification
- Appeals handling
- Claim resolution
- Revenue cycle management
- EHR systems
- ICD-10 coding
- Compliance management
- Healthcare regulations
- Healthcare Administration
- Data entry
- Problem-solving
- Teamwork and collaboration
- HIPAA compliance
Timeline
Outpatient Authorization & Reimbursement Coordinator
ADVENTIST HEALTHCARE REHABILITATION HOSPITAL
10.2025 - Current
Lead Patient Access Specialist
ASTRAZENECA PHARMACEUTICALS
06.2022 - 04.2025
Administrative / Receptionist
SIMMONDS, MARTIN & HELMBRECHT
04.2021 - 01.2022
Program Specialist
COVANCE
03.2021 - 04.2021
High School Diploma -
Saint Croix Central High School