Sherly Smith
@sherlysmith
I improve healthcare compliance, CMS readiness, and post-discharge care coordination at Humana.
United StatesWhat I'm looking for
I've supported Humana's Clinical Operations since 2010, improving Model of Care performance, remediating care gaps, and reporting clinical and operational metrics for leadership.
As a Senior Compliance Professional, I serve as a subject matter expert for compliance audits, CMS reporting, program alignment, policy updates, and compliance-related meetings. Earlier at Humana, I coordinated post-discharge outreach for high-risk Medicare members, identified care gaps, and escalated members to disease or case management programs.
Before healthcare, I supported ADA compliance and accessibility accommodations at Royal Caribbean Cruise Lines and resolved complex guest booking, billing, and service concerns. I recently completed Humana's AI Medical Coding Program and am seeking an internal opportunity to strengthen patient outcomes and regulatory excellence.
Experience
Work history, roles, and key accomplishments
Collaborate cross-functionally to assess Model of Care (MOC) performance and drive gap remediation efforts. Analyze and report on clinical and operational metrics to inform leadership decisions.
Provided administrative support across utilization management workflows, ensuring appropriate member services. Interpreted department policy and exercised discretion to prioritize care support needs.
Conducted outbound calls to high-risk Medicare members within 72 hours of hospital discharge. Identified care gaps using screening tools and coordinated interventions.
Ensured ADA compliance and exceptional guest service for travelers with mobility, visual, hearing, and cognitive impairments. Served as liaison between shoreside staff and shipboard personnel.
Special Handling Desk – Guest Sales Relations
Jan 2003 - Jan 2005 (2 years)
Resolved escalated travel agent and guest concerns regarding bookings, billing, and service issues. Investigated complaints by reviewing booking and accounting data.
Customer Service & Billing Associate
Pawtucket Mutual Inc.
Jan 2002 - Present (24 years 7 months)
Handled payments, batch billing, AR processing, and customer inquiries. Ensured accuracy of financial records per GAAP and internal standards.
Education
Degrees, certifications, and relevant coursework
Florida International University
Bachelor of Science, Hospitality Management
Bachelor of Science in Hospitality Management from Florida International University.
Johnson & Wales University
Associate of Science, Travel, Tourism & Hospitality
Associate of Science in Travel, Tourism & Hospitality from Johnson & Wales University.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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