SHARI SMITH
Tangent,OR
Summary
A motivated self-started, able to adapt quickly to change, and quickly grasp issues and pay attention to details. Great at handling multiple projects at the same time and completing tasks in a timely manner. Flexible, resourceful, and organized, able to quickly conform to changing priorities and maintain a positive attitude and superb work ethics. A clear and neutral communicator, able to easily develop relationships with both clients and colleagues, and motivate individuals to achieve objectives of the organization.
Overview
15
15
years of professional experience
Work History
PLAN DOCUMENT SPECIALIST
PacificSource
09.2022 - Current
- Serves as a subject matter expert for plan document information
- Develops and maintains plan and agreement language for self-funded plan materials
- Analyzes, revises, and manages documentation ensuring proper use of grammar and adherence to technical writing standards
- Coordinates with communications on all custom self-funded documents
- Communicates with multiple departments to ensure clear communication between all constituents
- Sets-up and communicates new and changing core plan document designs, requirements, and new formatting styles
- Maintains self-funded plan materials from pre-filing (if required) through post-implementation, ensuring consistency in language and compliance with state, federal, and other regulatory entities per company policies and procedures
- Liaises with other departments in order to establish and maintain consistent language and operation requirements and support in relation to the organization's sales, materials management, production and overall operating functions
- Attends internal and external meetings as required
- Works to identify potential issues and seeks resolution(s)
- Serves as key internal contact to solve problems for document issues relating to plan documents, SBC’s, ASO agreements, and amendments
- Identifies process improvements for document creation and accuracy for all self-funded products sold or represented by PacificSource
- Follows legal and compliance procedures for review of all self-funded documents (Plan Document, Amendments, SBCs, and ASO Agreements)
- Maintains job aids on the self-funded materials
- Prepares Plan Documents, Agreements, Plan Amendments, SBC’s or other documents for internal and external use
- Supports the product filing process by reviewing and auditing forms for self-funded filings including but not limited to stop loss contracts, plan documents and agreements
- Supports the commercial filing process by reviewing and auditing plan documents, benefit summaries, and SBCs during workflow
- Coordinates with sales and tracks all self-funded materials to ensure that PacificSource receives signed required documents for self-funded plans
- Evaluates returned documents to confirm all documents were received and are fully executed
- Publishes plan documents, SBC’s, amendments or other materials as required on web sites
TAX PROFESSIONAL
H&R Block
01.2010 - Current
- Provides continuous, exceptional support to the office and clients
- Schedules appointments, files documents, performs prior client call backs, and communicates with clients over the phone to answer any tax questions
- Interviews clients, reviews income tax documents, inputs data into Work Center and prepares client and small business tax returns
- Continually researches federal and state rules and regulations and stay abreast of tax law changes
- Processes client payments and processes the end of the day cash balancing
MEMBER EXPERIENCE PROGRAM MANAGER
Samaritan Health Plans
07.2021 - 09.2022
- Collaborated and executed the Samaritan Health Plan member experience program strategy for all lines of business
- Supported the strategy for a cross-organizational governance structure to integrate the SHP member experience with the overall Samaritan Experience
- Facilitated member and plan communications, contributing to overall member engagement
- Developed strategies focused on interpreting the voice of the member, creating line of business specific member engagement measurements
- Contributed to the collaboration with public and private entities to maintain a health care delivery system that meets the needs of members and the community
- Supported the strategy focused on improving the electronic interface member engagement program
- Supported assigned client relationships by maintaining a professional working relationship and ensuring contract compliance
- Facilitated on-going service needs by interfacing with internal and external customers, vendors and SHPO functional areas to meet customer requirements
ACCOUNT MANAGEMENT COORDINATOR
Samaritan Health Plans
04.2016 - 07.2021
- Responsible for meeting client’s business objectives and ensuring contract and regulatory compliance
- Precisely applied and implemented applicable regulations and health plan policies
- Pursued guidance and escalated concerns when appropriate
- Communicated and responded to internal and external customer questions regarding enrollment processes, claims administration, contracted providers, referral procedures, coding/billing information and general policy questions
- Consistently maintained the knowledge necessary to respond to inquiries accurately and constructively
- Provided cross training to Account Management Specialists
- Assisted in compiling policies, bid requests and requests for proposal (RFP) accurately and within required timeframes
- Participated in projects and in the resolution of issues as they arose
- Documented and completed internal paperwork for plan changes or other requests as assigned and ensured timely resolution/execution of changes
- Managed changes required of plan materials for member and provider correspondence and ensured they were compliant
- Provided guidance to staff regarding plan benefits, eligibility requirements and processes
- Assisted in developing training materials as applicable
- Coordinated open enrollment activities with Marketing, Member Services and other functional areas to meet department retention and acquisition goals, accountable for both individual and team outcomes
- Attended meetings and provided minutes, and updated materials to Account Management Team and Director as assigned
- Functioned as SHPO liaison, supported relationship management efforts through ongoing customer contact
- Presented any escalating items or unknown issues from the meetings or client interactions to Account Management Principal and/or Director
- Participated in contract review, summarized contract changes and provided input into the viability of proposed contract changes
- Had assigned specialized focus in the following areas: Auditing (internal compliance assessments and benefits), Benefit clarification research, Invoice processing and reconciliation, Website change maintenance and compliance, Disabled dependents review coordination, Member and plan material updates, Maintenance of plan reporting requirements, Regulation and rule research
ACCOUNT MANAGEMENT SPECIALIST
Samaritan Health Plans
04.2015 - 04.2016
- Provided excellent customer service to members and external vendors
- Collaborated closely with various functional teams to answer questions and problem solve
- Researched federal and state rules and regulations
- Documented processes and create work instructions
- Monitored reporting deadlines and ensured that reports were submitted in a timely manner
- Created logs and kept track of processes, issues, and deadlines
- Attended meetings and took meeting minutes
- Quality checked documents to ensure accuracy
- Created member materials and mailed to members
- Uploaded documents to internal site for internal teams to access
- Uploaded documents to the member portal for members to view documents for their health plan
- Provided back up and support to other plans within the Account Management team as necessary
FINANCIAL SPECIALIST II
Samaritan Health Services
07.2012 - 04.2015
- Provided excellent customer service to patients needing help with their bills
- Answered billing questions
- Added insurance to member accounts and processed claims
- Took patient payments and posted the payments to the account
- Reviewed accounts to make sure insurance properly added and claims processed correctly
- Processed insurance payments and posted to patient accounts
- Opened patient correspondence and contacted patients about billing issues and questions
- Scheduled appointments and met with patients to understand their bill
Education
Tax Preparer License -
H&R Block Income Tax School
Salem, ORB.S. - Business Administration
Eastern Oregon University
La Grande, ORSkills
- 13 years’ experience providing excellent customer service
- 13 years’ experience performing office functions
- 13 years’ experience working in a healthcare setting
- A motivated self-starter, able to adapt quickly to change, and quickly grasp issues and pay attention to details
- Great at handling multiple projects at the same time and completing tasks in a timely manner
- Flexible, resourceful, and organized, able to quickly conform to changing priorities and maintain a positive attitude and superb work ethics
- A clear and neutral communicator, able to easily develop relationships with both clients and colleagues, and motivate individuals to achieve objectives of the organization
Timeline
PLAN DOCUMENT SPECIALIST
PacificSource
09.2022 - Current
MEMBER EXPERIENCE PROGRAM MANAGER
Samaritan Health Plans
07.2021 - 09.2022
ACCOUNT MANAGEMENT COORDINATOR
Samaritan Health Plans
04.2016 - 07.2021
ACCOUNT MANAGEMENT SPECIALIST
Samaritan Health Plans
04.2015 - 04.2016
FINANCIAL SPECIALIST II
Samaritan Health Services
07.2012 - 04.2015
TAX PROFESSIONAL
H&R Block
01.2010 - Current
Tax Preparer License -
H&R Block Income Tax School
B.S. - Business Administration
Eastern Oregon University