Nancy Smith Email & Phone Number

Tennessee, United States

Responsible for directing the team managing clinical application implementations, training, EHR support and telehealth technology within a correctional setting. Currently overseeing a staff including Clinical Account Managers, EHR Trainers, Clinical App Support Manager, Business Analysts, Clinical Solutions Analysts, Project Management, and Telehealth Analyst. Facilities are currently utilizing 4 different EHRs, 3 of the EHRs are supported by this team with a consulting role for the contracts with their own EHR. Duties include leading the team to define, analyze, improve, and launch efficient delivery process improvement opportunities across all functional areas within the IT Customer Solutions group. Provide direction and oversight to the IT account managers and IT site leads responsible to promote EHR and clinical workflow adoption, serve as an IT liaison, and escalation to resolve issues quickly providing support to our site leadership. Oversee the EHR Change Committee with collaboration across all departments. Lead IT Business Development initiatives providing IT language and budgets for RFP responses. Review IT requirements and determine appropriate responses collaborating with IT Leadership, Client Clinical, Financial and Operational teams.

Remote

Responsible for directing the team managing clinical application implementations, training, EHR support and telehealth technology. HOCS Inc is a managed service provider (MSP), a third-party company that remotely manages a customer’s information services and technology. Currently providing management for a correctional medical vendor overseeing a staff including Clinical Account Managers, EHR Trainers, Clinical App Support Manager, Business Analysts, Clinical Solutions Analysts, Project Coordinator, and Telehealth Analyst. The client assigned currently has 19 contracts with 78 facilities utilizing 5 different EHRs, 3 of the EHRs are supported by this team with a consulting role for the 2 contracts with their own EHR. Duties include leading the team to define, analyze, improve, and launch efficient delivery process improvement opportunities across all functional areas within the IT Customer Solutions group. Provide direction and oversight to the IT account managers and IT site leads responsible to promote EHR and clinical workflow adoption, serve as an IT liaison, and escalation to resolve issues quickly providing support to our site leadership. Oversee the EHR Change Committee with collaboration across all departments. Lead IT Business Development initiatives providing IT language and budgets for RFP responses. Review IT requirements and determine appropriate responses collaborating with IT Leadership, Client Clinical, Financial and Operational teams.

Brentwood Tn

Promoted to Sr. Director position as company downsized closing a 2nd corporate office. Kept all existing duties with added responsibilities for other areas of IT. Led team to define, analyze, improve, and launch efficient delivery process improvement opportunities across all functional areas within the IT Customer Solutions group. Provided direction and oversight to the IT account managers and IT site leads responsible to promote EHR and clinical workflow adoption, served as an IT liaison, and escalation to resolve issues quickly providing support to our site leadership. Led IT Business Development initiatives providing IT language and budgets for RFP responses. Review IT requirements and determine appropriate responses collaborating with IT Leadership.

Create and maintain a comprehensive project management roadmap for implementations servicing all business functions to ensure project management execution and implementation plans are aligned with business objectives and IT strategies. Oversee project resources required to implement EHRs within correctional facilities executing aspects of complex, multifaceted, interrelated projects to meet critical milestones and objectives. Established the methodology, procedures and tools used by IT Implementations team using best practices. Lead team to define, analyze, improve, and launch efficient delivery process improvement opportunities across all function areas within the IT Customer Solutions group. Oversee clinical application support team who deliver level 2 and 3 support to end users 24/7 and the application development to optimize clinical workflows. Successfully implemented an EHR application in 36 of our facilities for 14 clients over a 3-year period

Franklin Tennessee

Responsible for managing teams within the Revenue Cycle Management Department for Premise Health worksite health centers where we provided management solutions for our clients. Developed first year budget. Worked with leadership team to separate business from Sellers Shared Services department thru a transition process. Created and implemented an exit plan strategy moving RCM work from Sellers internal and back-office staff to existing staff and new back-office vendor.

Franklin Tennessee

Responsible for managing teams within the Central Billing Office for Walgreens integrated workplace health centers where we provided management solutions for our clients. Management responsibilities included the temporary billing staff for the health centers transitioning from a paper process, managed the certified coding team who performed medical chart coding audits ensuring coding compliance, and managed the team members who performed insurance credentialing. Created budget and monitored department budget to actuals. Participated as the CBO representative in all new health center implementations for the CBO. Initiated and completed process improvement initiatives including creation of dashboards reflecting various work status; improved tool used at work sites to track and report payment activity on-site used for posting and bank reconciliation; led improvement project for the benefit matrix used to track benefits per client that are being administered by the CBO. Have led and participated in many cross functional committees and work groups

PMO was moved from IT to Corporate. Continued to lead team of project managers on all IT initiatives including application development, EHR Conversions, data extracts and imports, patient portals, intranet implementations per department. Led and participated in multiple committees and workgroup.

Built and managed the IT PMO for the Franklin Corporate office. Hired and managed all IT business analysts and project managers. Developed and implemented processes and procedures including templates for project management of small to large IT project initiatives primarily for software development. Directed the project team in the development and implementation of SharePoint Project Central used as tracking and dashboards for all projects and work being performed by IT resources. Produced and delivered reporting to IT leadership. Created and managed department budget to actual. Served as the IT liaison to the business leadership and managers providing immediate follow-up and tracking to ensure resolution. Led and participated in multiple committees and workgroups. Initially hired to fill a Quality Analyst role which was the immediate need as this position didn't exist for the organization at the time hired. Quickly promoted into the IT Business Services Manager position created in the IT Department utilizing previous management skills to assist in a growing IT department. Led team of project managers on all IT initiatives including application development, EHR Conversions, data extracts and imports, patient portals, intranet implementations per department. Led and participated in multiple committees and workgroups.

Contracted with the Commissioner of the Dept. of Commerce and Insurance in Tennessee to complete medical claim settlements for managed care companies in liquidation pursuant to the statutory liquidation process. Responded to member or provider inquiries and requests. Drafted communications to providers and members regarding liquidation process or resolution to issues. Maintained communications regarding IS issues with software vendor for the claims processing system. Created remittance advices for check distribution. Reviewed and processed all proof of claim appeals and objections. Produced reports or data files using AS400 SQL query functions. Audited and reprocessed medical and dental claims as needed. Reviewed provider and facility contracts to determine claim accuracy. Maintained communications with the attorneys and staff involved in the liquidations

Primary responsibilities included the planning, directing, and coordinating of the claims review process and resources in order to provide the expected results of liquidating a managed care company. Managed staff of 11 claims analyst. Conducted claim audits prior to releasing payments throughout the liquidation. Reviewed provider and facility contracts to determine payment accuracy. Identified and participated in the recovery of claims overpayments. Created and maintained policies and procedures for the claims run-out process. Provided customer service to the providers, members, and vendors. Drafted communications to providers and members regarding the liquidation process and resolution to issues. Created remittance advices and checks for check distributions. Completed member, provider, and reference updates to the claims processing system as needed. Produced reports and data files on a routine and ad hoc basis using standard reports and AS400 SQL query functions. Continued as IS liaison with DST HEALTH SOLUTIONS, INC for the claims processing application.

Responsibilities for managed care organization with 125,000 TennCare (Medicaid) members, included increasing the staff from 3 to 25 employees and the continued oversight of a 25 person IS staff of project manager, systems analysts, FoxPro programmers, EDI specialists, AS400 computer operators, and HIPAA compliance specialists. Created and maintained department policies and procedures in compliance with state contracts and company directives. Provision of first level response and problem solving for all software issues for the claims processing system. On-going oversight of claims, provider, member, and benefit data to support company’s service goals and the development of strategic long-term planning to support organizational growth goals. Daily responsibilities included planning, directing, and coordinating all information, data processing and reporting systems to support the managed care organization.

Responsible for ongoing system analysis to identify and propose business solutions. Assisted with the development of companywide training programs. Major projects included the following: 1.) Management of the Y2K Project for the managed care organization resulting in a successful compliance audit by the State of Tennessee and the Bureau of TennCare. This project included creating the project plan, obtaining approval from all senior staff, coordinating all departments in assigning, gathering, and reporting aspects of the plan, managing the testing phase prior to Y2K, implementation, mitigation, and reporting to management and the state entities throughout the process 2.) Conducted an audit of all hospital contracts, which yielded system corrections and reduced processing errors

Responsible for the budget development, hiring, training and development of Claims staff. Directed departmental expansion from 35 to 120 employees and extended operations to three shifts to meet demand. Enhanced the development and distribution of management reports. Reorganized the department to achieve greater efficiency and establish document control. Established mailroom procedures to sort, prepare, and scan all documents, and established data entry unit, processing unit and appeals unit. Managed the call center for provider claim appeals. Successful implementation and staff training for Macess DocFlo Program. Successfully managed claims backlog inherited through company acquisition. Developed and implemented claims backlog reduction plan resulting in a 200,000 plus claims reduction within three months. Developed and implemented department policies and procedures for all lines of business. Ongoing analysis of the system to identify automated claims processing errors. Promotion to Project Manager to support company focus on system integrity and training.

Managed call center and enrollment units for all lines of business. Staff included a team of 30 telephone representatives and administrative assistants. Responsible for budget development, hiring and training of staff, maintenance of enrollment data, customer retention, member education and maintenance of department policies and procedures. Successfully elevated staff performance levels that exceeded established service metrics by implementing customer service training and call monitoring program. Increased overall quality of customer interactions through implementation of the Macess program. Developed, implemented, and measured quality improvement work plans. Continued managing all claims processing for the Commercial line of business and managed TPA relationship for enrollment maintenance and customer support

Recruited to manage the development and launch of the Commercial product including creation of all associated operating departments and creation of all initial policy and procedures. Key responsibilities included: Setup and management of the member services, claims, enrollment, data entry, and underwriting departments. Managed and trained new staff. Developed marketing, operational forms and workflow procedures in conjunction with third party marketing firm. Maintained all duties of this position when promoted to the Customer Relations Manager

Network Marketing Company. Managed an office for a group of entrepreneurs during the development and implementation phase of several netowrk marketing companies. Duties included managing personnel, employee training, commission accounting, insurance agent/client services, GL, AR/AP, and Payroll.

Office Manager for Third Party Administrator. Duties included management of Billing and Commissions; Accounting functions (payroll, GL, AR/AP); MIB reporting, Underwriting assistant; production of insurance proposals; issuing of group/individual policies; managed claims entry process and maintained software updates and backups. Worked directly with the Vice President to develop systems using software to maintain computer production logs and generate monthly reports.