Summary
Overview
Work History
Education
Skills
Timeline
Generic

Colby Smith

Atlanta

Summary

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to evolving business needs. Eager to contribute to team success and further develop professional skills. Brings positive attitude, commitment, and result focused actions to continuous learning and growth,

Overview

11
11
years of professional experience

Work History

Clinical Review Analyst II

Elevance
12.2020 - Current
  • Interface with external payor platforms, understanding the complex rules related to authorization extraction and acceptance processes
  • Collaborate with national team members including IT, Eligibility, Claims and Customer Service
  • Prioritize and apply complex business rules to unique situations
  • Aid in developing policies and procedure edits/needs in support of providers and contract holder
  • Supervise landlord Network Connect profile process and implementation
  • Support testing of all system modifications and migrations, Communicate system issues to management
  • Facilitate operational needs for enhancements on business application and reporting to support contract holder and providers
  • Provide professional, accurate and appropriate feedback, assess trends, influence training opportunities
  • Evaluate clinical authorizations for procedural/technical completeness and accuracy.
  • Query and distribute clinical data reports
  • Centralize and resolve troubleshooting need for providers. Manage multiple customer service queues
  • Liaise with platform users to address issues beyond troubleshooting
  • Train operations team members for onboarding and interdepartmental demands
  • Assist with devising project plans for operations, housing, and provider reactions teams

Clinical Services Assistant

Beacon Health Options
05.2014 - 12.2020
  • Assist Utilization team with daily admissions to contracted facilities for review
  • Coordinate information of inpatient admissions with PPOE contactor to compare authorization submission in Elevance platform
  • Review clinical reports for accuracy of submissions, discharges, and Outpatient request
  • Oversee customer service/eligibility/claims and providers related inquiries to resolve issues with troubleshooting, updates, and error resolution.
  • Help facilitate weekly utilization team meeting when necessary
  • Maintain clinical calendar in share point site
  • Train temporary staff on care/service connect tools
  • Submit expense reports when necessary for clinical leadership
  • Additional duties as assigned

Education

Nursing

Clayton State University
Morrow, GA

Psychology

Armstrong Atlantic State University
Savannah

Skills

  • Ability to identify, analyze, and articulate business needs and requirements
  • Strong ability to analyze data and create actionable insights for business stakeholders
  • Understanding of various Elevance business platforms
  • Understanding data integrity and the ability to work with large datasets
  • Excellent written and verbal communication skills to articulate complex concepts to interdepartmental teams and users
  • Ability to present findings, make recommendations, and communicate changes clearly to all parties involved

Timeline

Clinical Review Analyst II

Elevance
12.2020 - Current

Clinical Services Assistant

Beacon Health Options
05.2014 - 12.2020

Nursing

Clayton State University

Psychology

Armstrong Atlantic State University

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Colby Smith