Myra Smith has over 10 years of experience in healthcare management focused on Medicare, Medicaid, managed care, appeals and grievances, and practice management. She currently works as a Senior Quality Review Analyst at McKesson Business Solutions where she reviews reimbursements, conducts data analysis, and collaborates on audits. Previously she held roles managing appeals and grievances at Universal American and supervising operations and claims at McKesson.

1. MYRA L. SMITH
8810 Sonny Boy Lane Apt. 3203Pensacola, Florida 32514 (850) 516-6782msmyralsmith96@hotmail.com
Professional Summary: Goal-oriented and results-driven professional with over 10 years experience in Healthcare Management
with focus on Medicare, Medicaid, Managed Care, Appeals and Grievances, and Practice Management Government audits such as
HEDIS and PERM.
PROFESSIONAL EXPERIENCE
MCKESSON BUSINESS SOLUTIONS, Pensacola, Florida 10/2010 – Present
Sr. Quality Review Analyst, Operations 06/2013
 Review and analyze reimbursements for accuracy in accordance with organizational and Federal guidelines and mandates.
 Conduct data analysis and promulgate report findings to Executive management for process improvement and trending
analyses.
 Collaborate with Compliance as a committee member to review and submit information pertinent to Government and internal
audits.

Managed Care Operations, Claims Supervisor 10/2010-06/2013
 Monitor operations to ensure adherence to departmental standards including productivity, financial, and data accuracy rates.
 Coordinate communications between provider offices and customer service department regarding claim payment and denial
issues.
 Analyze physician administrative appeals and provide recommendations for improvements to senior management.
ACCUSTAFF, Pensacola, Florida 06/2010-10/2010
Front Desk Receptionist
 Monitored and documented visitor safety measures.
 Filed safety and confidentiality affidavits signed by all visitors.
 Answered and transferred incoming calls.
UNIVERSAL AMERICAN, Houston, Texas 05/2002-06/2010
Appeals and Grievances Quality Manager
 Monitored compliance and quality management efforts to support accreditation and regulatory objectives .
 Trained and mentored staff on the Center for Medicare and Medicaid Services guidelines and regulations as pertaining to
Medicare Advantage and Part D health plans.
 Analyzed and reported trends regarding appeals and grievances.
Appeals and Grievances Manager 10/2007-01/2009
 Supported and communicated with network operations, providers and vendors regarding care coordination, access to quality
care, and resolution of members’ appeals and grievances.
 Monitored the timeline and processing of all appeals and grievances regarding The Center for Medicare and Medicaid Services
guidelines.
 Researched and presented findings to the Quality Improvement Committee all appeals and grievances trends.
Appeals and Grievances Supervisor 06/2005-10/2007
 Subject Matter Expert on guidelines for Appeals & Grievances as dictated by the Center for Medicare and Medicaid Services.
 Coordinated efforts for appeals and grievances as pertinent to Part D Operations.
 Supervised and trained employees on processing complaints received through the Center for Medicare and Medicaid Services
Complaint Tracking Module.
 Implemented a successful training program for new hires.

2.  Liaised with Governmental staff to discuss and resolve complaints.
 Promoted teamwork within the department and ensured excellent customer service standards were met.
 Communicated findings and status updates on complaints to senior management.
Agent Licensing Representative 05/2002-06/2005
 Assisted Insurance brokers and applicants through the hiring process
 Conducted local and state background checks for applicants
 Mentored and trained new employees on departmental processes and workflows.
EDUCATION
Currently enrolled Pensacola State College Pensacola, Florida
HealthcareManagement
2009 – 2010 Houston Community College Houston, Texas
General Studies
COMPUTER SKILLS
Proficient with the use of Trizetto Facets and Microsoft Office Suite products.