Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Shawanda Smith

Norfolk

Summary

Experienced in medical coding to ensure accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Enrollment Data Analyst III

Elevance Healthcare
Norfolk
01.2016 - Current
  • Research and analyze clients' claims.
  • Maintains and updates enrollment profiles for assigned markets, often requiring high-volume data entry.
  • Monitors receipts of the State Enrollment file and communicates issues to management.
  • Respond to enrollment verification requests and update applications accordingly.
  • Researches and resolves eligibility inquiries.
  • Researches and resolves membership discrepancies identified through monthly and weekly reports.
  • Analyzes and resolves moderate to complex errors resulting from automated file updates.

Senior Customer Service Representative

Citi Group
Norfolk
03.2009 - 12.2016
  • Documented customer interactions for follow-up and process improvement initiatives.
  • Escalated complex issues to appropriate departments for prompt resolution.
  • Consulted with customers regarding needs and addressed concerns.
  • Assisted customers by answering questions, addressing concerns and providing current account information.
  • Managed incoming calls from customers while providing exceptional service.
  • Educated customers about products, pricing and policies to address and resolve issues.

Education

Certificate - Medical Billing & Billing

Tidewater Community College
Norfolk, VA
07-2025

High School Diploma -

Booker T Washington HS
Norfolk, VA
06-1995

Skills

  • Medical coding
  • Review medical records documentation in support of Evaluation and Management CPT codes
  • Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits
  • Translate medical policies into reimbursement rules
  • Prepares correspondence to providers regarding coding and fee schedule updates
  • Coordinates research and responds to system inquiries and appeals

Certification

  • Certified Professional Coder ,2025

Timeline

Enrollment Data Analyst III

Elevance Healthcare
01.2016 - Current

Senior Customer Service Representative

Citi Group
03.2009 - 12.2016

Certificate - Medical Billing & Billing

Tidewater Community College

High School Diploma -

Booker T Washington HS

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Shawanda Smith