Courtney Weeks Smith
Baton Rouge,LA
Summary
Dynamic healthcare operations professional with over 9 years of experience in provider enrollment, claims resolution, audits, and compliance within managed care environments. Proven ability to maintain accurate provider records, effectively resolve provider-related claim issues, and consistently meet service level agreements while fostering collaboration between internal teams and external providers. Expertise in leveraging tools such as Facets, Epic, and Microsoft Office to enhance operational efficiency and drive positive outcomes. Committed to delivering high-quality support that aligns with organizational goals and improves overall healthcare delivery.
Overview
10
10
years of professional experience
Work History
Quality Reviewer
Blue Cross and Blue Shield of Louisiana
Baton Rouge, LA
01.2025 - 09.2025
- Conducted approximately 30-35 review of claims, enrollment, and billing transactions to ensure accuracy, compliance, and adherence to organizational guidelines per day from processing staff.
- Identified and resolved provider- and system-related issues impacting claims processing.
- Maintained detailed audit logs and reports to support compliance and operational effectiveness.
- Provided training and technical guidance to staff on benefits, systems, and regulatory requirements.
- Collaborated with internal departments to resolve discrepancies and improve claims outcomes.
Medicare Secondary Specialist
Blue Cross and Blue Shield of Louisiana
Baton Rouge, LA
01.2023 - 01.2025
- Researched and maintained accurate coordination of benefits (COB) and Medicare order of payment to ensure cases were handled correctly.
- Ensured timely claims processing in compliance with CMS regulations and deadlines.
- Resolved provider and payment discrepancies to prevent overpayments and financial risk.
- Worked cross-functionally with internal teams and CMS to support accurate provider claims resolution.
- Adjusted and processed claims according to 60 days deadlines.
Claims Specialist II: Office of Group Benefits
Blue Cross and Blue Shield of Louisiana
Baton Rouge, LA
03.2022 - 01.2023
- Analyzed and resolved 80+ complex claims and provider records, ensuring accurate payment determinations per day.
- Completed quality audits and corrected errors within established turnaround times.
- Supported special projects related to audit findings and process improvements as needed.
Claims Specialist I: Commercial COB
Blue Cross and Blue Shield of Louisiana
Baton Rouge, LA
03.2020 - 03.2022
- Updated and maintained 100 or more claims and provider data to ensure accurate coordination of benefits.
- Identified and resolved provider-related claim issues, including denials, edits, and reprocessing.
- Conducted research to determine correct payment order and reimbursement accuracy.
Account Advisor I: Federal Employee Program
Blue Cross and Blue Shield of Louisiana
Baton Rouge, LA
01.2018 - 03.2020
- Facilitated efficient communication for provider and member inquiries related to benefits and claims management daily with a high volume of calls.
- Surpassed 98% performance benchmarks through effective first-call resolution and rigorous service standard maintenance.
- Presented comprehensive benefit and provider information in a clear and professional manner to facilitate informed decision-making.
Control Clerk: Special Claims Review
Blue Cross and Blue Shield of Louisiana
Baton Rouge, LA
02.2016 - 01.2018
- Generated productivity and compliance reports to support operational tracking.
- Maintained documentation and records for claims batching and processing workflows.
- Supported office operations and ensured accurate handling of incoming provider and member mail.
Education
No Degree - Business Administration
Bossier Parish Community College
Bossier City, LA05.2029
Skills
- Support for provider enrollment processes
- Thorough record upkeep
- Claims processing
- Facets
- CMS & Regulatory Compliance
- SLA compliance
- Provider & Member Communication
- Documentation management
- Skilled in Microsoft Word, Excel, Access, and Outlook
Timeline
Quality Reviewer
Blue Cross and Blue Shield of Louisiana
01.2025 - 09.2025
Medicare Secondary Specialist
Blue Cross and Blue Shield of Louisiana
01.2023 - 01.2025
Claims Specialist II: Office of Group Benefits
Blue Cross and Blue Shield of Louisiana
03.2022 - 01.2023
Claims Specialist I: Commercial COB
Blue Cross and Blue Shield of Louisiana
03.2020 - 03.2022
Account Advisor I: Federal Employee Program
Blue Cross and Blue Shield of Louisiana
01.2018 - 03.2020
Control Clerk: Special Claims Review
Blue Cross and Blue Shield of Louisiana
02.2016 - 01.2018
No Degree - Business Administration
Bossier Parish Community College