BRIAUNA SMOOT
Owings Mills,MD
Summary
Accomplished professional with over 12 years of progressive expertise in delivering solution-driven support within healthcare-focused domains. Recognized for exceptional analytical prowess, adeptly aligning business priorities through meticulous data assessment, research, and assistance. Proficient critical thinker, skilled in devising standardized training modules and protocols, while seamlessly integrating novel methodologies. Demonstrated business acumen and proficiency in overseeing diverse operational facets, encompassing regulatory adherence, audit functions, and staff growth. Adept communicator, both written and verbal, with a proven track record of being a dependable resource for stakeholders at all organizational tiers. Proficient in scrutinizing substantial data volumes to ensure precision, thoroughness, and policy compliance. Enthusiastic candidate committed to applying analytical and problem-solving proficiencies in a professional context. Expert in collecting and dissecting research data, with an unwavering commitment to accuracy. Reliable leader with robust leadership capabilities tailored for mentoring and guiding students. Adaptable and flexible, showcasing resilience in dynamic work environments.
Overview
13
13
years of professional experience
Work History
National Consultant Graduate Intern
Kaiser Permanente
06.2023 - Current
- Collaborated with a diverse team to contribute to projects that align with the company’s strategic objectives
- Developed comprehensive reports and conducted data analysis to support decision-making processes
- Gained valuable experience in project management, including planning, execution, and performance measurement
- Adapted quickly to new applications and technologies to support various business objectives
- Job-shadowed professionals from other functional areas to gain a broader understand of the organization operations
- Created benefits grids, processed updates to the Outreach Tracker for future engagements
- Effectively assisted in the creation of Confirmation Packets
- Assumed additional duties as required, demonstrating flexibility and adaptability in a dynamic work environment.
Health Plan Specialist II
Kaiser Permanente
06.2015 - 06.2023
- Successfully supported the compliance, quality assurance, and employee development objectives of the organization by performing research and reporting functions for a department that provided member services support via phone and email
- Independently managed an average of 50 calls and 40+ emails per day from members and providers regarding insurance plans, claim status, contract interpretation, and technical support while maintaining a 99% average in quality assurance
- Maximized Customer Service Representative productivity by spearheading an internal system for tracking real-time stats (hold times, # of calls, after call work), which improved self-evaluation efforts and encouraged CSRs to meet daily goals
- Improved the employee development and training process by creating training resources for new hires on workflow processes and department policies while facilitating monthly coaching through call monitoring and evaluations
- Prioritized member and provider outcomes by analyzing data from various sources (patient medical records, explanation of benefits, medical bills) to provide benefits information, cost estimates, deductibles, payment plans, and billing assistance
- Boosted member retention and satisfaction by performing complex research to review and investigate discrepancies with account information and billing while providing alternatives on health plan selections based on individual needs
- Strategically influenced provider satisfaction by performing detailed analysis on pending, paid, or denied claims to provide information regarding the appeals process with a focus on educating providers on the policies as it relates to medical claims
- Proactively maintained accurate and detailed notes on all member and provider interactions (follow-up attempts, account changes, billing resolutions) to ensure proper documentation for all future calls, questions, and concerns.
Customer Service Representative II
CareFirst of Maryland Inc
01.2011 - 06.2015
- Effectively contributed to the compliance and member/provider satisfaction goals of the organization by providing customer- service centric support via email and phone with a focus on data analysis, benefit interpretation, and first contact resolution
- Maximized member and provider satisfaction by providing support in understanding their healthcare coverage, through contract interpretation, providing benefit utilization support, and claims analysis for an average of 50 calls/emails per day
- Boosted compliance efforts by serving as the lead on the Special Audit Unit from 2013 till 2015; led the resolution of priority cases/grievances filed by members and providers by auditing email communications to determine the facts of the case
- Enhanced the training process for the new provider inquiry line; assisted in the creation of the SOPs and workflows for
- Customer Service Associates to follow; implemented evaluation and productivity standards to ensure provider satisfaction
- Performed outreach for members requiring additional assistance to include account level research, summary of benefits coverage and educating members on products and services aligned with their specific needs
- Optimized the member experience by escalating various member issues/complaints to the appropriate parties to reduce attrition, focusing on identifying the root cause of the issue to achieve timely resolution
- Strategically supported the training and development of 15+ Customer Service Associates, including consistently evaluating performance through real-time observations and audits; provided feedback in the employee annual review process.
Education
Bachelor of Science - Business Administration, Healthcare Management
Colorado Technical University
MBA - Healthcare Management
Colorado Technical University
Skills
- SOFTWARE/TECHNOLOGICAL PROFICIENCY
- EPIC ACI Common Archival Retrieval System (CARS) Mainframe Service Health Plan (SLP) Chats
- Data Collection
- Special Projects
- Delivery Assurance
- Analysis
- Customer Support
- Team Member Development
- Working with Consultants
- Analysis and Evaluation
Timeline
National Consultant Graduate Intern
Kaiser Permanente
06.2023 - Current
Health Plan Specialist II
Kaiser Permanente
06.2015 - 06.2023
Customer Service Representative II
CareFirst of Maryland Inc
01.2011 - 06.2015
Bachelor of Science - Business Administration, Healthcare Management
Colorado Technical University
MBA - Healthcare Management
Colorado Technical University
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