Ka-Ron Smith Email and Phone Number

A senior healthcare leader with over 25 years of consulting experience, specializing in transforming healthcare operations for national and regional organizations. I am skilled in business process redesign, outsourcing, service delivery, IT system integration, and business analytics, with a focus on aligning strategies to enhance operational efficiency and drive measurable outcomes. Known for expertise in process improvements, service delivery enhancements, and strategic IT solutions, I empower healthcare organizations to optimize performance and adapt to evolving industry demands.Currently seeking additional contract roles as a Lead Business Architect, Senior Business Analyst, Senior Business Consultant/Advisor, or Project Manager within the healthcare industry, I bring years of hands-on experience managing, planning, and implementing business operations and performance improvement projects across payer and provider sectors. My approach integrates process improvement with technology solutions to streamline healthcare management.My core areas of expertise include:Business Process Redesign: Requirements development, operational assessments, use case development, and offshore process implementation.Strategic Initiatives: Extensive experience in report and network development, process mapping, strategic planning, provider contracting, product design and implementation, and business transformation.Specialized Knowledge: Core claims systems integration, 5010/ICD-10 compliance, and revenue cycle enhancement.

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Oversaw the Correspondence Workstream for HealthRules Claim implementation at a start-up health plan, managing critical communications including Enrollment, EOBs, and Provider Remittance. Conducted a business requirements assessment to migrate Medicaid functions to Facets, led gap analysis and core claims modernization efforts, and provided QA oversight for value stream process modeling. Managed a team to improve claims process-es and ICD-10 compliance, and directed CMS submission redesign to align with EDPS standards.

Led discovery and design phases for system integration across multiple workstreams, providing business analysis support for detailed design and configuration. Facilitated workshops for future state processes, documenting busi-ness rules, use cases, UML diagrams, and inter-departmental workflows to ensure seamless integration into the QNXT system

Led the implementation of Sales Process Management BPO for a large West Coast health plan, aligning delivery functions with customer requirements. Developed the structure for JAD sessions, managed the Pega process de-livery team, and documented comprehensive requirements, process flows, screen designs, and reports for the Sales Process Management phase, supporting smooth operational transitions.

Directed RFP development for Core Claims, Medical Management, Sales, and Underwriting Systems for a regional health plan, managing requirements analysis and vendor scoring. Oversaw corporate billing initiatives to address pain points, redesigned workflows for offshore reporting support, and delivered solutions for national health plan web enrollment, enhancing user experience and operational efficiency.

Developed business requirements and a financial-tier model for network stratification, implementing a hospital tier-ing program based on cost and efficiency. Led contract management system selection, created processes for 24 critical payment categories, redesigned process flows for member care continuity, and developed a narrow net-work product for large-scale membership migration, supporting premium savings and cost efficiency.

Performed KPI analysis for access to care, quality, and financial impact, creating a model to replace traditional medical management. Developed a rapid-performance improvement plan for a regional facility to stabilize cash flow and strategic viability, and conducted Medicare cost-report audits to ensure regulatory compliance and accu-rate cost allocation