Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Michael K Smith

Port Richey,FL

Summary

Dynamic leader with extensive experience at United Healthcare, excelling in provider relationship management and team leadership. Demonstrated success in enhancing provider relations, improving service delivery through effective problem-solving, and leading high-impact training programs. Skilled in policy interpretation and adaptability, consistently achieving goals with a focus on significant achievements.

Overview

18
18
years of professional experience

Work History

Senior Provider Relations Advocate

United Healthcare
Tampa, FL
10.2012 - Current
  • Maintained professional relationships with healthcare providers, as well as maintaining positive working relationships with internal partners, fellow staff, and management.
  • Collaborated with internal teams such as network management, claims and adjustments, CMOs, clinical teams, payment integrity, and legal, to name a few, on initiatives related to provider relations.
  • Conducted outreach activities to build relationships with providers in the network.
  • Provided guidance, education and training to new providers on contractual requirements and policies.
  • Identified areas for improvement, narrowing focus for decision-makers in making necessary changes.
  • Analyzed provider feedback to identify areas of improvement in service delivery.
  • Participated in events such as seminars, webinars, or conferences for healthcare providers to discuss industry updates or changes in policy.
  • Managed daily operations within the Provider Relations department while ensuring adherence to quality standards set forth by the organization.

Operational Claims Trainer

United Healthcare
Oldmar, FL
08.2007 - 10.2012
  • Assessed training needs through surveys, interviews with employees or focus groups.
  • Analyzed data from post-training evaluations and suggested improvements for future classes.
  • Coordinated with subject matter experts to ensure accuracy of course content.
  • Explained goals and expectations required of trainees.
  • Provided guidance on professional development opportunities for claims processors.
  • Facilitated group discussions and activities to promote knowledge sharing among trainees.
  • Monitored progress of trainees throughout the program and provided additional instruction as needed.
  • Developed and delivered training programs to support the claims process.
  • Provided feedback on performance of new hires during their training period.
  • Used role-playing, lectures, and simulations to present information in variety of instructional techniques and formats.
  • Maintained records of employee attendance at training events and tracked completion rates.

Health Insurance Claims Processor

United Healthcare
Oldsmar, FL
09.2006 - 08.2007
  • Maintained confidentiality of policyholder information in compliance with HIPAA regulations.
  • Followed up on pending claims and resolved issues delaying processing.
  • Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
  • Processed claims for payment or forwarded to appropriate personnel for further investigation
  • Verified accuracy of information on claim forms before submission.
  • Collaborated with fellow team members to manage large volume of claims.
  • Evaluated appeals from denied insurance applications or requests for reconsideration.
  • Provided training and guidance to new claims processors on department procedures.
  • Calculated benefits due to claimants based on applicable laws, rules, regulations, or company standards.
  • Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.

Education

Associate of Science - Business Administration And Management

St. Petersburg College
Clearwater, FL
09-1995

Skills

  • Provider relationship management
  • Policy interpretation
  • Educational presentations
  • Provider orientations
  • Issue research
  • Task prioritization
  • Written communication
  • Teamwork
  • Problem-solving abilities
  • Adaptability and flexibility
  • Excellent communication
  • Team leadership

Accomplishments

  • Make it Matter Hall of Fame Inductee 2024
  • Service Heroes Recipient 2022
  • Recipient of numerous Bravo's for performance and collaboration

Timeline

Senior Provider Relations Advocate

United Healthcare
10.2012 - Current

Operational Claims Trainer

United Healthcare
08.2007 - 10.2012

Health Insurance Claims Processor

United Healthcare
09.2006 - 08.2007

Associate of Science - Business Administration And Management

St. Petersburg College

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Michael K Smith