Kelli B. Smith
Laurel,MD
Summary
Focused Clinical Director with a background spent overseeing personnel and regulatory concerns. A highly collaborative leader with skills in assigning caseloads, participating in meetings with clinical staff and ensuring that facility policies are observed. Offering exemplary communication and organizational skills.
Overview
14
14
years of professional experience
Work History
Director of Clinical Quality Operations
Inovalon, Inc
06.2019 - 06.2023
- Lead and directed the execution of quality, clinical design, oversight, training and support to internal and external stakeholders (including Offshore Vendor management) for all Risk Adjustment (CARA HCC, Commercial HIX, Medicaid CRG, RADV), HEDIS and Perspective Advantage (ePASS) projects.
- Managed day-to-day operations of the Clinical Quality Operations Department including on-site and remote staff, Team Leads (Supervisors) and Quality Management personnel (300+ associates).
- Partnered to oversee the training, career development, review process, retention, daily coordination and management of personnel to achieve a successful balance of operational and service provision, as well as financial fiduciary responsibility.
- Coordinated processes involved in Clinical Quality Auditing and Quality Oversight Programs (utilizing Natural Language Processing (NLP) and TruCode Encoder).
- Developed, implemented, revised, and evaluated policies and procedures.
- Developed and monitored strategic metrics to successfully track quality identification and improvement, productivity and costs (utilizing Tableau, Inter-Rater Reliability (IRR) data).
- Assisted in the development and pursuit of financial, human resources and other operations strategies which enhance revenue generation, quality outcomes, efficiency, customer service delivery capabilities, satisfaction and ultimately enterprise value of the Company.
- Assisted in the development and maintenance of systems which deliver direct feedback, quality/process counseling and coaching, retraining and when necessary reassignment or termination decisions for the Clinical Quality Operations Department regarding quality issues.
- Identified and coordinated quality improvement initiatives across the clinical quality oversight process including but not limited to project management, consultation, facilitation and execution for a range of clinical, multi-dimensional strategic initiatives that required planning and analysis for a broad array of complex clinical and operations issues.
- Responsible for the quality, training, learning, development and quality monitoring programs related to these initiatives across Company services.
Clinical Quality Manager
Inovalon, Inc
06.2014 - 06.2019
- Managed a team of six (6) Quality Leads and their associates while providing strategic guidance, coaching, mentoring and direction.
- Project Manager and Subject Matter Expert (SME) for the CARA Risk Adjustment HCC Project; however, well versed in all Risk Adjustment and Quality Outcome projects.
- Collaborated with the Quality Assurance Team (QAT), Preceptor Team, Learning & Development (Training) and Operations to ensure consistency in guidelines.
- Tracked trends through Lead and QAT Analysis and provided pertinent information for Training, updates to Reference Manual(s), Quality Matters Newsletters and overall quality improvement.
- Provided succinct guidance and information to the Quality Team.
- Planned strategically for efficient processes and methods to improve the chart review process and ensure accurate results.
- Facilitated Team Meetings in order to develop staff, build team camaraderie and ensure overall quality outcomes.
- Assisted in the implementation and improvement of SAFHIRE and the Data.
- Collection Desktop (DCD) (internal data systems).
Quality Assurance Team (QAT)
Inovalon, Inc
12.2012 - 06.2014
- Managed a team of nine (9) associates.
- Aided in developing QAT processes, assignments and initiatives.
- Facilitated meetings in order to develop staff and build team camaraderie.
- Tracked trends through Accuracy Analysis and provided pertinent information for training, manual updates, Quality Matters Newsletters and QAT Learning & Development.
- Reconciled Accuracy Analysis Discrepancies through the use of the QAT Discrepancy Board.
- Ensured consistency and timeliness of Accuracy Analysis Reports sent to Overreaders, Leads and Quality Managers.
- Maintained role of Lead Coding Data Review Consultant.
- Documented nonconforming material and reported to appropriate team leaders for review and assessment.
- Adapted procedures to mitigate issues and improve deficiencies.
Lead Coding Data Review Consultant
Inovalon, Inc
12.2009 - 12.2012
- Managed a team of 10 to 15 associates.
- Monitored daily work flow by creating reports in order to keep track of team’s productivity and job performance.
- Completed Annual Appraisals and Performance Evaluations for all employees.
- Developed content for and conducts monthly team meetings.
- Developed and issued Performance Improvement Plans for those employees performing below standard.
- Managed and approved timecards via UltiPro for employees.
- Verified appropriate certification/licensure for employees.
- Use of Microsoft office for daily tasks (Microsoft Word; Microsoft Excel; Microsoft PowerPoint; Microsoft Outlook).
- Performed quality overreads to ensure accuracy.
- Completed monthly maintenance reviews on all employees.
- FRAT Extension Team Member (responsible for the organization of maintenance and feedback for SRC’s).
- Managed the Risk Adjustment Lead Roundtable meetings (scheduling; preparing the agenda and minutes; created SOP).
- Interviewed incoming Remote and In-House staff.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Resourcefully used various coding books and procedure manuals.
- Member of the Morale Booster Committee.
Education
Degree - Nursing
Howard Community College
Bachelor of Science - Kinesiology
University of Maryland at College Park College Park
Skills
- Clinical Quality Improvement
- Clinical Staff Management
- Electronic Medical Record Software (NLP, TruCode Encoder)
- Oversight of Accuracy and Productivity
- Microsoft Office (Word, Excel, PowerPoint)
- Experience in ICD-10 Coding
- Training and Onboarding
- Clinical Quality Program Standards
- Staff Development
Affiliations
Exceeds Expectations on Performance Evaluations
Recipient of the Achieve Ambassador Award
Member of the MRR Quality Policy Review Committee
Member of the 2015 Performance Management Steering Committee
Timeline
Director of Clinical Quality Operations
Inovalon, Inc
06.2019 - 06.2023
Clinical Quality Manager
Inovalon, Inc
06.2014 - 06.2019
Quality Assurance Team (QAT)
Inovalon, Inc
12.2012 - 06.2014
Lead Coding Data Review Consultant
Inovalon, Inc
12.2009 - 12.2012
Degree - Nursing
Howard Community College
Bachelor of Science - Kinesiology
University of Maryland at College Park College Park
Similar Profiles
Kavithalakshmi BaskarKavithalakshmi Baskar
Principal Software Data Engineer at Inovalon, IncPrincipal Software Data Engineer at Inovalon, Inc
PETER CHINPETER CHIN
HCC Quality Assurance Coder III at Inovalon, IncHCC Quality Assurance Coder III at Inovalon, Inc
Todd PulhamTodd Pulham
Manager, Customer Success at Inovalon, IncManager, Customer Success at Inovalon, Inc