Gib Smith Email & Phone Number

Portland, Oregon Area

NAIRO (National Association of Independent Review Organizations) is a collaborative group of 32 leading independent review organizations (IROs) that provide independent medical reviews which help payors and medical managers to improve quality of care, medical utilization and patient safety and protect the integrity of the independent review process. From a patient perspective, NAIRO and its affiliate members can provide detailed guidance regarding patient rights and other important issues pertaining to IROs and the independent medical review process.

Purcellville, Virginia

Provide corporate counsel and compliance services for a variety of clients including independent review organizations (IROs) and related healthcare entities. Provide business development, proposal management and writing services in a variety of fields including federal and state appeals, independent medical review, utilization review, Medicare, Medicaid managed care, welfare-to work, quality of care, disability, case management, and other healthcare related areas.

Advised the President/CEO, CFO, Board of Managers, management and other staff regarding legal, compliance and business issues. Increased MCMC success rate for requests for proposals (RFPs) and applications to more than 60 percent by developing and managing MCMC business development and proposal process to identify new business opportunities and business trends. Expanded MCMC’s business markets by 30 percent by managing the successful completion of MCMC’s URAC Independent Review Organization (IRO) and Utilization Management (UM) accreditation applications. achieved IRO certification in 18 States and in 12 States as a Utilization Review Organization (URO) by completing more than 30 applications. Helped eliminate a one year contract backlog and significantly increase company revenue by eliminating/mitigating time consuming contract approval delays. This included ensuring timely completion of all company/client contracts by creating and developing contract templates for each line of business, consultants, and HIPAA security/privacy compliance and a contract control process to ensure timely completion of all company/client contracts. Aided MCMC in being seen as the expert in health rule/regulation legislation issues by developing and implementing a comprehensive company-wide compliance program for these types of inquiries/correspondence, including policies and procedures and a training program.

Responsible for new business development for the MAXIMUS Center for Health Dispute Resolution (CHDR), which operates the Nation’s largest system for the resolution of health insurance appeals through independent external review. Managed the technical aspects of all proposals and application efforts on behalf of MAXIMUS CHDR and for ensuring legislative and regulatory compliance with all 27 State-mandated independent review projects.Improved win ratio for CHDR applications/RFPs to more than 75 percent. Developed and maintained MAXIMUS CHDR marketing and capture plans, conducted market and competitor research, and supervised direct sales. Appeal Officer, The Center for Health Dispute Resolution.Responsibilities contract interpretation, medical necessity review, legislative/regulatory compliance, a thorough understanding of Medicare regulations and current health care trends, and issuance of final determination letters. Director, Health Management Services Division Implemented and managed of six Medicaid Managed Care and Children’s Health Insurance Project (CHIP) contracts totaling more than $100 million dollars and 1.5 million recipients. Responsibilities included staff supervision, Medicaid managed care enrollment, fulfillment management, client outreach and education strategies, creation of program materials, recruiting and hiring, development of policies and procedures, institution of training regimens, and negotiation and oversight of subcontracts with various vendors to support project operations.

Director, Ombudsman Program Pioneered a national advocacy program to assist childhood cancer patients, survivors, and their families experiencing difficulties relating to a diagnosis of cancer. Designed services and programs including access to insurance coverage, insurance reimbursement, fair employment practices guaranteed under the Americans With Disabilities Act and other civil rights laws, the enforcement of special education rights and resources, vocation and rehabilitation planning, securing government benefits, and the facilitation of a second-opinion service to ensure families make well-informed treatment choices. Director, Survivors Program Created a survivors network providing a vehicle for survivors to exchange information and support, including a Survivors Handbook addressing the multitude of post-treatment issues survivors encounter, providing practical ideas, solutions and resources for managing them.

Ba, History

Activities and Societies: Phi Alpha Theta Historical Honor Society

Jd, Law