Summary
Overview
Work History
Education
Skills
Timeline
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Renesia Smith

Montgomery,NY

Summary

Enthusiastic individual experienced in analyzing complex issues and finding effective and creative solutions that contribute to organizational growth and efficiency. Through previous experience have developed strong analytical skills, keen attention detail and quality. Ready to bring 5 years of relevant work experience to a new position in the technological industry.

Overview

8
8
years of professional experience

Work History

Provider Configuration Analyst

Molina Healthcare
01.2021 - Current
  • Checked documentation for accuracy and validity on updated systems.
  • Generated, posted and attached information to claim files.
  • Conduct audits of health plan's Provider Inquiry/Services operations for quality and accuracy, as prescribed by established internal audit policies and procedures and based on audit schedule for each functional area within department.
  • Collect and audit data, analyzes/interprets results, and prepares written reports of findings to management.
  • Processed 80-120 claims per day while maintaining 99.8% quality standard
  • Prepared CM-related documentation for on-time delivery

Medicare Risk Adjustment Customer Care Specialist

Humana
11.2016 - 01.2018
  • Utilized electronic medical record systems to store, retrieve and process patient data.
  • Maintained accuracy, completeness, and security for medical records and health information.
  • Tracked and monitored requests for medical records release.
  • Implemented various research methods through FACETS and other applications to validate current Provider demographics.
  • Completed various special projects, including CNA research, vendor projects, and data clean up.
  • Increased department accuracy by 8% resulting in improvement of HEDIS score

Launch and Training Specialist

SkuVault
03.2016 - 09.2016
  • Assisted in analyzing and assessing training and development needs for organizations, departments and individuals.
  • Drafted and produced online training manuals, and start up tool kits for warehouse management programs.
  • Prepared videos for online and remote instruction.
  • Traveled to client locations to conduct live product demonstrations.
  • Analyzed issues to identify troubleshooting methods needed for quick remediation.
  • Responded to support requests from end-users and patiently walked individuals through basic troubleshooting tasks.
  • Researched product and issue resolution tactics to address customer concerns.
  • Created user accounts and assigned permissions.
  • Monitored system performance to identify potential issues..
  • Established and maintained quality control standards.
  • Completed between 30-40 help desk tickets per week.

Education

High School Diploma -

Western School of Technology & Environmental Sci.
Baltimore, MD
06.2010

Skills

  • Detail Oriented
  • Analytical Problem-Solving
  • Excel
  • Data Analysis
  • Risk Assessment
  • Records Review
  • Training and Development
  • Systems Analysis
  • Troubleshooting
  • Application Support
  • Telephone Support
  • SQL

Timeline

Provider Configuration Analyst

Molina Healthcare
01.2021 - Current

Medicare Risk Adjustment Customer Care Specialist

Humana
11.2016 - 01.2018

Launch and Training Specialist

SkuVault
03.2016 - 09.2016

High School Diploma -

Western School of Technology & Environmental Sci.

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Renesia Smith