Myeshia Smith
Toano
Summary
Experienced healthcare operations and claims professional with 15+ years of progressive experience within Elevance Health, specializing in claims processing, quality auditing, operation support, workflow improvement, and associate training. Strong background in researching and resolving complex claims issues, analyzing operation processes, and supporting business initiatives within high volume healthcare environments. Proven ability to collaborate across departments, develop process documentation, manage escalations, and improve operational efficiency. Seeking to leverage healthcare claims and expertise and analytical problem solving skills in a Business Analyst role.
Overview
24
24
years of professional experience
Work History
Operations Expert
Elevance Health
Richmond, VA
12.2015 - Current
- Streamlined operational processes to enhance efficiency and reduce waste across departments.
- Developed training materials and conducted sessions to elevate team performance and knowledge retention.
- Implemented data analysis tools to track key performance indicators, driving informed decision-making.
- Led cross-functional teams in process improvement initiatives, resulting in enhanced service delivery standards.
- Serves as a primary operational resource for associates regarding workflow processes, technical issues, and claims related inquiries.
- Research and resolve complex operational escalations by analyzing claim issues and coordinating with internal departments to ensure timely resolution.
- Monitor workflow inventory and aging reports to identify processing delays, support productivity goals, and improve operation efficiency.
- Collaborate with peers and leadership to establish and implement operational best practices across the department.
- Develop and maintain process documentation and workflow guidance materials to support consistency and accuracy in day to day operations.
- Train and mentor associates on new processes, workflow changes, and benefit updates to improve team performance and accuracy.
- Support implementation of process updates and benefit changes while ensuring compliance with organizational procedures.
- Assist with identifying operational improvement opportunities through analysis of recurring issues and workflow trends.
- Serve as subject matter resource for claims operations and internal process related questions.
Performance Quality Auditor I
Elevance Health
Richmond, VA
05.2015 - 12.2015
- Conducted comprehensive quality audits to ensure compliance with regulatory standards and organizational policies.
- Developed and implemented quality improvement initiatives that enhanced operational efficiencies across departments.
- Trained and mentored junior auditors on best practices in quality assessment and documentation procedures.
- Identified, documented, and reported transaction errors and process deficiencies to support prompt issue resolution and operational improvement.
- Researched claim discrepancies and collaborated with operation teams to resolve complex claims related issues.
- Assisted associates with questions related to claims processing procedures and correspondence responses.
- Served as a resource for claims processors and operational staff in the absence of leadership support.
- Supported process consistency and quality improvement initiatives through detailed transaction analysis and reporting.
Claims Representative III
Elevance Health
Richmond, VA
03.2007 - 05.2015
- Processed and adjusted professional and facility healthcare claims for Virginia state employees and retirees in a high volumee production environment efficiently while ensuring compliance with company policies and regulatory requirements.
- Resolved customer inquiries and disputes, improving client satisfaction and retention rates.
- Analyzed claim data to identify trends and recommend process improvements for operational efficiency.
- Collaborated with cross-functional teams to streamline claims processing procedures, enhancing overall service delivery.
- Reviewed claims for eligibility, benefits determination, coordination of benefits, and reimbursement accuracy.
- Resolved complex provider and member inquiries through detailed claims research and problem solving.
- Maintained productivity, quality and adherence standards while managing multiple priorities and deadlines.
- Coordinated benefits between insurance carriers to ensure accurate claims processing and payment determination.
- Assisted team members through one on one coaching and process guidance to improve overall department performance.
- Communicated with providers and members by phone, email and written correspondence regarding claims resolution and benefit information.
Customer Service Representative I
West Telemarketing
Hampton, VA
11.2005 - 03.2007
- Resolved customer inquiries and issues efficiently through multiple communication channels.
- Provided detailed product information to enhance customer understanding and satisfaction.
- Collaborated with team members to improve service quality and workflow processes.
- Maintained accurate records of customer interactions and transactions for future reference.
- Performed troubleshooting and issue resolution to ensure customer satisfaction and service continuity.
Team Lead/Verifier/Customer Service Representative
Sitel Corporation
Savannah, GA
09.2002 - 10.2005
- Led cross-functional teams to enhance customer engagement strategies and service delivery standards.
- Developed training programs to improve team performance and operational efficiency.
- Streamlined workflow processes, reducing response time for customer inquiries.
- Implemented quality assurance protocols to ensure adherence to service level agreements.
Education
Associate of Arts - Business
University of Phoenix
Tempe, AZ11-2010
Skills
- Healthcare Claims Processing
- Claims Auditing & Quality Review
- Business Process Analysis
- Workflow Improvement
- Operational Support
- Claims Research & Resolution
- Reimbursement Policies & Procedures
- Root Cause Analysis
- Data Review & Reporting
- Microsoft Excel
- Documentation Development
- Cross Functional Collaboration
- Escalation Management
- Associate Training & Mentoring
- Inventory & Aging Monitoring
- Problem Solving & Analytical Research
Timeline
Operations Expert
Elevance Health
12.2015 - Current
Performance Quality Auditor I
Elevance Health
05.2015 - 12.2015
Claims Representative III
Elevance Health
03.2007 - 05.2015
Customer Service Representative I
West Telemarketing
11.2005 - 03.2007
Team Lead/Verifier/Customer Service Representative
Sitel Corporation
09.2002 - 10.2005
Associate of Arts - Business
University of Phoenix