Shannon Smith
Summerville,SC
Summary
Proficient professional bringing several years of experience working in compliance-related roles. Good communication and planning skills with a methodical and disciplined approach.
Overview
17
17
years of professional experience
Work History
Accreditation Compliance Manager
BlueCross BlueShield of SC
Columbia, SC
06.2023 - Current
- Conducted internal audits to identify areas of non-compliance and recommend corrective actions.
- Developed and implemented policies and procedures to ensure compliance with applicable laws, regulations, standards, and best practices.
- Provided guidance on complex regulatory issues to senior management and other departments.
- Created reports outlining compliance activities for executive leadership review.
- Assisted with the development of training materials for employees regarding compliance requirements.
- Reviewed contracts for accuracy and ensured they meet corporate objectives while adhering to applicable law and regulation.
- Facilitated meetings between stakeholders including executive leadership, legal counsel, department heads., to discuss compliance matters.
- Completed internal and external audits according to established procedures.
- Built and strengthened relationships with regulatory representatives, vendors and company customers.
- Maintained compliance standards for all contract deliverables.
ACCREDITATION COMPLIANCE ANALYST
BlueCross BlueShield SC
Columbia, SC
01.2023 - 06.2023
- Responsible for leading accreditation compliance activities to include interpretation of standards, monitoring of multiple areas’ compliance, providing guidance to management and associates on compliance issues. Provides HEDIS support for multiple departments. Assists in the oversight and management of Quality Improvement Initiatives.
• Leads accreditation compliance activities including review and interpretation of standards, monitoring of multiple areas for compliance as well as developing and implementing quality improvement activities to improve compliance.
• Researched and monitored CMS rules and regulations around HEDIS, Stars and Risk and perform compliance analysis and inform management of any changes.
• Conduct/ participate in audits of areas such as member services and utilization management, to ensure compliance with NCQA activities or to assess service issues.
• Analyze audit results and make appropriate recommendations for changes to improve compliance or level of service, work with other departments to prepare a corrective action plan and prepare formal documentation of the audit.
• Assist with special accreditation/HEDIS projects/activities, as assigned by management, including tracking, trending and profiling; perform quality service reviews and investigate quality of service complaints to take necessary actions to improve clinical and service performance.
• Coordinates and prepares committee minutes.
• Reporting of quality of care
COMPENSATION ANALYST
Haynes Incorporated
Charleston, SC
01.2018 - 07.2020
- Global Compensation, Pay Processing, LEPay Processing (CGFS/GC/PPR/LE)
The Compensation Analysts primary responsibilities are T&A reporting (bi-monthly), pay
calculation, individual leave accounts, allotments of pay, and other individual pay matters for those
paid under local compensation plans at serviced-posts.
● Received, researched, analyzed, and processed specialized pay actions.
● Responsible for accuracy of calculating and processing Time and Attendance into a various
proprietary financial systems, ensuring timeliness and accuracy of information.
● Processed accounts by organization or country code by conducting a variety of transactions
affecting pay, leave, taxes, benefits and other deductions.
● Verified personnel actions and personal service contracts/agreements prepared by
serviced Embassies, rejecting those who are not properly completed or in accord with existing
personnel law, regulation and advises post personnel offices of the deficiencies and corrections
needed to affect the action.
● Audited, analyzed and reconciled reports or accounts.
● Performed manual calculations when deemed necessary to verify year-to-date adjustments.
● Researched, corrected and determined the cause of erroneous payments and timely clearing of
domestic and overseas T&A rejects.
● Calculated overpayments made due to system deficiencies, preparing proposed repayment
schedules, communicating those proposals to the employees and entering collections in
accordance with the Federal Government.
● Prepared financial reports on various aspects of the payroll cycle, as requested by DoS.
mailto:shannontilford@yahoo.com
Confidential Resume of Shannon Tilford Smith Page 2 of 4
Honors: United States Department of State Certification of Appreciation in recognition of
continuous improvement of LE Payroll ISO-9001 Reference Documents and Work Instructions to
increase efficiency, productivity and reduce errors.
BUSINESS ANALYST
BlueChoice Healthplan
Columbia, SC
01.2012 - 01.2017
- Conducted business process analyses, needs assessments and cost/benefits analyses while
ensuring efforts to align operations solutions with business initiatives were successful. Provided
project leadership for high-level divisional or departmental projects to include testing efforts and
managed and allocated available resources. Additionally:
● Acted as escalation point for issues in Billing;
● Prepared monthly statistics and audit reports;
● Managed special projects directed toward strategic business and other organizational
objectives;
● Prepared and disseminated communications to appropriate internal and external stakeholders;
● Conducted research projects, reports and presentations as assigned;
● Collaborated with Senior Management to develop, implement and monitor performance and
targeted goals;
● Conducted business process analyses and needs assessments for Operational development;
● Perform triage, root cause analysis and corrections to data issues.
● Managed (HICS) Health Insurance Casework system processes and X12 files for Marketplace
operations;
● Provided leadership by coordinating and integrating Billing services within the department.
CORPORATE TRAINER
BlueCross BlueShield of Tennessee Inc.
Columbia, SC
01.2008 - 01.2012
- Responsible for conducting technical and non-technical classes for a variety of employees such as
new hires, outsourced individuals and existing employees, while managing various projects
including audit compliance, international outsourcing and first call resolution customer service
outreach. Additionally:
● Developed student and facilitator manuals, power point presentations, job aids and interactive
computer resources for enhanced learning;
● Tracked and monitored team interactions and provided feedback to trainees;
● Conducted virtual training and assisted in process development for international trainees;
● Demonstrated sophisticated written and oral communication skills to coordinate highest level of
management to front line employees for training needs and scheduling;
● Maintained database of training activity, produced reports, graded tests, and collected and
compiled survey information.
Education
Bachelor of Science - Management
Limestone College
Columbia, SC05-2008
Skills
- Audits management
- Document reviews
- Compliance documentation
- Regulatory compliance oversight
- Document analysis
- Training Coordination
- Internal Audits
- Data gathering and reporting
- Analytical Thinking
- Training and education
Timeline
Accreditation Compliance Manager
BlueCross BlueShield of SC
06.2023 - Current
ACCREDITATION COMPLIANCE ANALYST
BlueCross BlueShield SC
01.2023 - 06.2023
COMPENSATION ANALYST
Haynes Incorporated
01.2018 - 07.2020
BUSINESS ANALYST
BlueChoice Healthplan
01.2012 - 01.2017
CORPORATE TRAINER
BlueCross BlueShield of Tennessee Inc.
01.2008 - 01.2012
Bachelor of Science - Management
Limestone College
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