Takara Smith
Zephyrhills,FL
Summary
Seasoned collaborator experienced in meeting needs, improving processes and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills. Highly analytical with a talent for solving complex problems and leveraging data to create actionable business insights. Experienced administrative professional with 8+ years in provider credentialing services. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans.
Overview
11
11
years of professional experience
Work History
Provider Credentialing Analyst II
Select Health
12.2022 - 07.2024
- Identified and implemented improvements to streamline credentialing processes and enhance efficiency.
- Conducted primary source verifications such as background checks and board certifications for prospective providers
- Periodically reviewed and re-verified the credentials of existing providers in Xcelys, Cactus, Wintergate and additional databases to ensure ongoing compliance with CAQH and CMS regulations.
- Serve as a liaison between the provider and the healthcare organization, facilitating the credentialing process.
Provider Data Liaison
Catalyst Solutions
01.2022 - 12.2022
- Supported statewide network development by researching, recruiting, and negotiating with providers
- Conducted over 130-160 audits monthly on medium to complex reports, identifying trends and patterns enhancing data accuracy by 74% for department
- Designed and developed data pipelines to acquire, clean and process data.
- Reviewed rates and fee schedules from contracts to obtain best pricing and service for organization.
Configuration Specialist II
Centene
03.2020 - 10.2021
- Analyzed business requirements to design and implement benefit changes, ensuring alignment with client needs
- Participated in various team projects, demonstrating the ability to work collaboratively and effectively.
- Managed plan benefits coding changes, UAT test execution, and validation for benefit design requests via Qnxt
- Coordinated responses to audits and ensured compliance with updated workflows and protocols
- Configured customized benefits enrollment platforms, assisting in implementation and maintenance.
- Kept CM work aligned with project's configuration management plan
Network Contract Negotiator
Humana
12.2017 - 12.2019
- Facilitated credentialing and re-credentialing processes by maintaining communication with facility and provider contacts
- Developed and enhanced relationships with more than 200 healthcare providers, improving network efficiency and profitability
- Managed network contracting and reimbursement processes to meet cost and quality requirements
- Ensured security and confidentiality of sensitive documents and data.
Lead Credentialing Specialist
Humana
12.2013 - 12.2017
- Ensured compliance with regulatory and accrediting institutions for provider credentialing and privileging maintained accuracy
- Managed documentation and presentation of provider credentialing files, including semi-annual re-appointments
- Acted as a liaison between the company and client hospitals for credentialing and privileging processes.
- Completed human resource operational requirements by scheduling and assigning employees.
- Conducted performance reviews and provided feedback regarding employee performance.
- Reduced expenses by analyzing compensation policies and implementing competitive programs while ensuring adherence to legal requirements.
Education
Associate of Applied Science -
St. Petersburg College
St. Petersburg, FL05.2018
Skills
- Provider Enrollment
- Credentialing oversight
- Human Resource Information Systems (HRIS)
- Applicant Trackins System
- User Acceptance Testing (UAT)
- Web-Based Reporting Tools
- Healthcare Administration
- CMS Claims Reporting & Fee Exception Negotiations
- Provider Contract Performance Monitoring
- Analytical Tool Implementation & Business Intelligence
- Microsoft Excel & Google Suite
- Software Development (Agile/EDI/SQL)
- Xcelys
- Facets
- CAQH/PECOS
- QNXT
Timeline
Provider Credentialing Analyst II
Select Health
12.2022 - 07.2024
Provider Data Liaison
Catalyst Solutions
01.2022 - 12.2022
Configuration Specialist II
Centene
03.2020 - 10.2021
Network Contract Negotiator
Humana
12.2017 - 12.2019
Lead Credentialing Specialist
Humana
12.2013 - 12.2017
Associate of Applied Science -
St. Petersburg College
Similar Profiles
Yatsive RobinsonYatsive Robinson
COMMUNITY RELATION'S SR. SPECIALIST at Select HealthCOMMUNITY RELATION'S SR. SPECIALIST at Select Health
Kjarsten A. PedersenKjarsten A. Pedersen
Compliance Consultant at Select HealthCompliance Consultant at Select Health
Sonia VillicanaSonia Villicana
Recovery Specialist /Prior Authorization Specialist at Select HealthRecovery Specialist /Prior Authorization Specialist at Select Health
Kathy ArnewKathy Arnew
Teacher at West Zephyrhills ElementaryTeacher at West Zephyrhills Elementary
Kelsey RogersKelsey Rogers
Biological Science Internship at Florida International University, FIUBiological Science Internship at Florida International University, FIU