MICHELE SMILEY
Indianapolis,IN
Summary
Experienced analytics professional with a background in business process improvement, quality assurance, and data analytics. Proficient in Lean Six Sigma methodologies, applying techniques to streamline workflows, enhance efficiency, and drive continuous improvement. Expertise lies in cultivating stakeholder relationships and implementing progressive solutions that optimize organizational performance.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Adjunct Instructor
Marian University
08.2024 - Current
- Lead students to a 100% passing rate through engaging lectures, personalized feedback, and tailored support
- Design and deliver rigorous, relevant curricula to align with academic and industry standards
- Support the academic growth of 15+ students per semester, maintaining high satisfaction ratings
- Improve student performance by defining clear goals and communicating performance metrics.
- Tailor lesson plans to accommodate various learning styles, resulting in better understanding for all students.
- Maintain accurate records of student attendance, assignments, and grades, ensuring timely communication with key partners regarding academic progress.
Medical Management Specialist SR.
Elevance Health
09.2014 - Current
- Achieve >95% compliance with state TAT benchmarks, ensuring timely case updates and preventing regulatory penalties.
- Improve process efficiency by ensuring seamless integration between Carelon and ACMP migrations, reducing delays in case reviews.
- Ensure audit readiness by maintaining 100% error-free documentation for State EQRO and NCQA audits.
- Provide HIPAA-compliant documentation and case management support to a clinical staff of ≥10.
- Develop data-driven insights and visualizations to refine processes, identify inefficiencies, and communicate operational improvements effectively.
- Enhance provider compliance by identifying and mitigating trends related to case errors and regulatory adherence.
- Serve as a liaison between in-network and out-of-network providers and internal teams, ensuring efficient communication and compliance with clinical measures.
- Foster effective communication with shared services (BH, CM, MPA, Appeals) by ensuring timely responses, accurate call transfers, and detailed communication logs
- Support cost-saving initiatives by analyzing FWA trends, identifying risk patterns, and collaborating with compliance teams to reduce financial inefficiencies in Medicaid programs.
Client Service Advocate
Anthem
01.2009 - 09.2014
- Created and maintained strong provider relationships by proactively addressing inquiries, claims adjustments, and compliance
- Educated providers on plan benefits, services, and policies to promote understanding and compliance
- Conducted detailed research and analysis to resolve provider issues without requiring follow-up, reducing rework and improving satisfaction
- Advocated for providers by addressing complex issues through whole-case methods, ensuring their concerns were resolved comprehensively
- Enhanced client satisfaction by addressing inquiries and resolving issues promptly.
- Monitored account activity, proactively addressing potential issues before they escalated into problems.
Education
Master of Social Work -
Indiana Wesleyan University
Marion, IN08-2025
Bachelor of Science - Social Work
Indiana Wesleyan University
Marion, IN10.2023
Associate of Science - Integrative Studies
Indiana Wesleyan University
Marion, IN05.2021
Skills
- Lean Six Sigma (DMAIC, Process Optimization, Root Cause Analysis)
- SQL (Principles, Queries & Data Insights)
- Artificial Intelligence Optimization
- Data Analysis, Reporting & Performance Metrics
- Statistical Modeling
- Proficient in Microsoft Office
- Audit Support
- Continuous Process Improvement
- End-to-End Management
- Government Business
- Managed Healthcare Operations
- Curriculum Design
- Diversity Engagement
Certification
- Lean Six Sigma Yellow Belt
Elevance Health
- Community Health Worker
Mental Health America
Timeline
Adjunct Instructor
Marian University
08.2024 - Current
Medical Management Specialist SR.
Elevance Health
09.2014 - Current
Client Service Advocate
Anthem
01.2009 - 09.2014
Master of Social Work -
Indiana Wesleyan University
Bachelor of Science - Social Work
Indiana Wesleyan University
Associate of Science - Integrative Studies
Indiana Wesleyan University
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