Tracey Smith-Reed

Experience

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  Administration Systems Research

  Jul 1999 - Oct 2007

  Medical Auditor/Stop Loss Coordinator

  Auditor/Trainer/Stop Loss Coordinator (Self-funded/Fully funded products)• Assisted in supervisor duties.• Audited medical, dental, vision, disability, and flexible spending claims.• Created, implemented, and maintained flexible spending training manual.• Built, implemented, and maintained the MBI Flexible spending Debit card program.• Trained medical, dental, vision, disability, flexible spending, and re-pricing.• Filed Stop Loss claims for reimbursement with Re-Insurance carriers and balanced books.• Handled Negotiations for high dollar out-of-network claims.• In house Re-pricing for Beech Street and Multi-Plan claims.• Processed medical, dental, vision and disability claims along with providing excellent customer service. Show less

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  Benefit Management Administrators, Inc

  Jan 2008 - Aug 2010

  Medical Insurance Claims Analyst

  Claims Analyst/Customer Service/Auditor• Claims processing/Audit/Customer service o Medical, HRA/HSA, Vision, Dental, Flex – medical/dependent care• Built and implemented the MBI Debit card program for processed and everyday functions.• Implemented auditing procedures for all claims processed.

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  Professional Benefits Services

  Oct 2012 - Sept 2015

  Medical Claims Auditor

  Claims Auditing Coordinator (October 2014 – September 2015)Medical/Dental/Vision/HSA/Flexible Spending/Short Term Disability• Implemented and trained claim processes and procedures for Self-funded products.• Completed random audit 3%-10% of all claims processed.• Reviewed and built all plans in WLT for accuracy.Claims Specialist/Team Lead (October 2012 - October 2014)• Team Lead/Assisted in Supervisor duties.• Medical Claims Processor / Customer Service.• Handled ALL rehab, occupational, and speech claims and repricing. Show less

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  Priority Health

  Sept 2015 - now

  Expert auditing knowledge of Claims, Product Coding, Product Building, Pricing functions, ad hoc audits, external audits, and conduct/reporting of monthly Performance Guarantee Groups.• Facets Product, Coding and Pricing configuration• Developed and implemented the Mock Audit program to compare Group Plans and Claims payment.• End to End corporate audit co-authored curriculum and implemented.• Mapping updates to align with services provided.• Compare Plan Document(s) to product(s) as designed with specific lens for Self-Funded products.• Record and report any discrepancies/deviations in plan documents and claim outcomes.• Identify potential opportunities regarding processes and areas of risk using root cause analysis.• Collaborate with team members to create troubleshooting as needed. Show less

  • Quality Improvement Specialist

    Jan 2020 - now

  • Quality Auditor

    Sept 2015 - Jan 2020