Keith Smith Email & Phone Number

Greater Atlanta Area

San Antonio, Texas, United States

I analyzed documents for provider enrollment and communicated results to CMS. I provided input regarding changes to policies and procedures.

Jacksonville, Florida

I conducted fraud investigations for the Medicare Medicaid Task Order 2 Contract for ZPIC Zone 7 in Florida. The investigations were based on a proactive approach utilizing data analysis to detect fraud, waste and abuse in the Medicare and Medicaid programs.

San Antonio, Texas

I was responsible for implementing the Medicare DME Stop Gap Project in Texas. Seven employees representing review nurses, investigators, administrative staff and a data analyst reported to me. I also conducted fraud investigations for the Medicare DME Stop Gap Project. The investigations were based on a proactive approach utilizing data analysis to detect fraud, waste and abuse in the Medicare program.

Atlanta, Georgia

I was responsible for managing the DMEPOS Audit and Provider Outreach departments. I determined the types of claims to be audited and worked with CMS and the Affiliated Contractors to recoup the overpayments. I also developed the Provider Outreach department for the national contract.

Columbia, South Carolina

I reviewed and interpreted Medicare regulations, developed and communicated guidelines to all departments to ensure compliant corporate policies and procedures. I delivered Medicare presentations to providers at the national, regional, and state conferences, and tradeshows. I resolved provider issues referred by the anti-fraud unit, various internal departments and state and congressional offices. I was the Medicare representative for North Florida.

Jacksonville, Florida, United States

I monitored Medicare regulations and provided physician clients impact analysis on their practice. I developed and marketed a customized line of consulting services designed to instruct physicians in the area of PPO, HMO, and Medicare reimbursement guidelines. I conducted Medicare seminars and published a quarterly newsletter and manual identifying the most recent guidelines for physicians throughout Florida. I provided on-site audit services for physicians to determine Medicare compliance.

Jacksonville, Florida, United States

I developed and delivered informational and educational presentations to physicians, medical societies, and other trade associations throughout Florida. I addressed critical claim processing and payment issues affecting physicians. I participated in formulating market strategies for HMO and PPO physician networks. I also marketed HMO and PPO products to the physician community, and negotiated contracts with selected physicians.

English Linguistics

Attended graduate studies in English Linguistics, University of South Carolina, Columbia, South Carolina B.A., International Studies.

B.A., International Studies