Armond Smith
Atlanta,GA
Summary
Dedicated and detail-oriented Healthcare Business Claim Analyst with years of experience in business health plan implementation, including commercial, Medicaid and Medicare plans. Proficient in interpreting complex medical and hospital claims, ensuring adherence to regulatory requirements, and optimizing reimbursement accuracy. Adept at resolving disputes, enhancing efficiency, and driving process improvements. Demonstrated expertise in data analysis, quality control, and a commitment to delivering exceptional results-driven team leadership.
Overview
8
8
years of professional experience
Work History
Associate Business Analyst
Commonwealthcare Alliance
04.2022 - Current
- Directed and supervised team of MAPD claims analysts, providing guidance and oversight to ensure accurate and timely processing of Medicare Advantage claims in accordance with CMS guidelines.
- Applied in-depth knowledge of CMS guidelines, ICD-10 codes, and CPT codes to review complex MAPD claims, resulting in reduction in claims denials and improved reimbursement accuracy.
- Fostered strong relationships with healthcare providers, internal departments and external partners, ensuring timely claims resolution, effective communication, and increased customer satisfaction.
- Led initiatives to streamline business process workflows, reducing redundancy and increasing overall efficiency, resulting in 25% reduction in average resolution time.
Claims Capability Analyst
United Healthcare
04.2021 - 04.2022
- Implemented new federal and state requirements, policies and process for 14 states entering new commercial lines of business
- Created new standard of operations to improve efficiency and quality for claim processing
- Coordinated with business partners and IT developers in designing, creating and communicating business needs for system functionality
- Analyzes data to identify trends and opportunities to improve business for business partners
Claims Subject Matter
Expert UnitedHealth Group
12.2016 - 03.2021
- Investigates, evaluates and adjust DSNP, medicare and medicaid claims in accordance with CMS standards and state laws using CSP Facets claim processing platform
- Performed analytical research on claim inventory trends identifying holds, denial codes and warning messages using Orbits and Tableau reporting
- Identifies processing trends seen across claims and collaborates with health plan and business partners
- Applies strong leadership talents and problem-solving skills to maintain workflows for over 30 processors to meet any daily demand
- Implemented strategies to increase overall learning curve efficiency to above 95% and quality to 90% accuracy for processors
- Conducts training sessions and coaching opportunities to processors to improve quality.
Claims Processor
United HealthCare Services Inc
02.2016 - 12.2016
- Paid or denied over 100 medicare/medicaid claims daily based upon SOPs using CSP facets processing platform
- Achieved 100% quality, accurately processing claims receiving no defects for all four quarters of 2017
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
- Communicated verification and authorization status updates to facilitate decision-making for patient admissions and EOBs.
Education
Bachelor of Science Professional - Interdisciplinary Studies
Jackson State University
Jackson, MS12.2018
Skills
- Microsoft Visio, Excel, Word, Outlook
- Data Analysis
- Medical Terminology
- Business process improvement
Timeline
Associate Business Analyst
Commonwealthcare Alliance
04.2022 - Current
Claims Capability Analyst
United Healthcare
04.2021 - 04.2022
Claims Subject Matter
Expert UnitedHealth Group
12.2016 - 03.2021
Claims Processor
United HealthCare Services Inc
02.2016 - 12.2016
Bachelor of Science Professional - Interdisciplinary Studies
Jackson State University
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