Sir or Ma’am,

 

As you will see from my enclosed resume, I have a strong technical background in addition to my Accounting and Finance education. While completing my undergraduate and graduate education at the University of Kentucky, I was employed with Lexmark as a Senior Associate in Software Technical Support working primarily with their business customers and clients on every commercially available operating system. I have also since worked as an auditor for the U.S. Department of Defense with responsibilities auditing both regional and national civilian contractors.  I am also proud to have served in the United States Navy.

More recently, in my role in private health insurance for both small and larger health plans, I was tasked with both bio statistical and financial analysis in support of virtually every facet of the business including but not limited to; financial reporting, formal financial board of directors’ presentations, budgeting, contract modeling, contract negotiation, monthly IBNR projections, underwriting rate setting group rate projections and analysis, RFP development, etc.  In this role, I had primary responsibility for utilizing an actuarial model from which to make most of the group rate and internal IBNR projections.  For on demand reporting and analysis, I utilized SQL based relational databases populated from various business modules because my analysis generally crosses multiple business functions.  I am likewise an expert or advanced user of Microsoft Office applications (Word, Excel, Access, Power Point, Outlook.) and in many cases can provide on demand automation of various types of reporting and analysis.

In my most recent role, my primary responsibilities relate to the review of State budget and expenditure submissions in my capacity as a Funding Specialist or in my blended dual role.  In addition, as an out stationed Funding Specialist, I was the first contact with various States to provide technical assistance to both avoid and remedy related financial and policy issues.  In my role as the Lead Coordinator of the regional managed care team, I also reviewed State submissions of initial and updated proposals for changes to managed care delivery systems, both waiver and State plan based.  I likewise acted to provide ad hoc technical assistance to our internal Centers for Medicare and Medicaid (CMS) staff, both within and outside the region nationally, on financial review issues.  I was finally the one and only national trainer for all CMS regional offices in the review of actuarially sound managed care contracts.  Alas, I was eventually forced to resign as my health declined due to a condition which I developed while in the Navy and for which I was likewise retired from the Navy.  I am currently undergoing new and promising treatments which may allow me to return to the workforce.  Until that date, I relay this in the hopes that full disclosure will be greeted with open minds given my past record of consistently providing benefits above and beyond the call of my roles to many diverse organizations.  I am happy to provide any number of references to attest to the same.  I appreciate your time and attention.

Please feel free to contact me with any further questions.

 

Thank you,

 

Edward M. Smith, M.S. Acc

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROFESSIONAL EXPERIENCE:

 

CENTERS FOR MEDICARE AND MEDICAID OPERATIONS (CMS), U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) – ATLANTA REGIONAL OFFICE    

[2009 – 2015]

• GS-13 FUNDING SPECIALIST / LEAD MANAGED CARE COORDINATOR, ATLANTA REGION (Blended Dual Role)

     Review of State Budgetary submissions:

- Review of State Title 19 and 21 budget submissions to ensure adherence to the State plan and compliance with

Federal regulations and statutes.

- Provide technical assistance to the State in completing and projecting out year budget projections. 

- Develop and implement models to review and quantify any material financial and program enrollment trend variances.

     Review of State Expenditure submissions:

- Review of State Title 21 expenditure submissions, and assist with reviews of State Title 19 expenditure submissions

to ensure adherence to the State plan and compliance with Federal regulations and statutes.      

- Review for approval of State TPL and ASO contracts. 

- Provide technical assistance to the State in resolving prior period expenditure adjustments.

- Provide technical assistance to the State with financial and policy issues related to proposed State Plan Amendments.

     Review of Medicaid Managed Care models and payment rates:

- Review for approval of State plan based or waiver based managed care delivery systems, initial and updated.

- Review for approval of managed care risk contracts to ensure compliance with Federal regulations and statutes.

- Review for approval of managed care risk contract actuarially certified capitation rates for compliance with Federal

  regulations and statutes. 

- Provide ad hoc technical assistance to Regional Office managed care team members on financial reviews.

- Maintain database of all ongoing reviews by State and provide feedback, support, and guidance for each member of the

  Regional Office managed care team.

- Nationally recognized by all Regional Office teams as expert in managed care finance, providing each of them with one   

  on one guidance by team and review as needed, including stepping in as proxy primary State contact for other regional

  offices nationally as required by the complexity of their ongoing state reviews.

     Medicaid Policy and Regulations:

- Construction and presentation of Regional Office managed care training of finance and policy staff of available

Medicaid managed care delivery systems, related regulatory and statutory review standards, and process

standards for reviews of cost effectiveness projections and actuarially certified monthly payment rates.

- Member of Medicaid Library and Policy Workgroup, developed data collection model for current PCCM reviews.

- National trainer of all Regional Office managed care teams in review actuarial soundness of managed care capitation

  payment rates and contract structure.

 

 

HUMANA – CHA HEALTH    

[2005 – 2008]

• SENIOR FINANCIAL ANALYST    

     Bio Statistical and Financial Analysis utilizing SQL based relational databases:

- Advanced user of Microsoft, Word, PowerPoint, Outlook.

- Expert user of Microsoft Excel and Access including utilization of array formulas in modeling, regression analysis,

  and database construction and deployment.

- On demand SQL and/or Access database query analysis including data integrity assurance reviews. 

- On demand database and spreadsheet modeling to provide automation of recurring and/or customized financial 

  reporting.

     Operational Reporting and Analysis relative to all facets of the business:

          - ROI analysis and support for internal project management.

          - Vendor and Provider contract modeling, analysis, and negotiation. 

          - Uncovered $88,000 in vendor overpayments within a week of restructuring vendor contract reviews.

          - Development of models for maintenance and manipulation of employee data.

     Financial Reporting and Analytical Support of monthly accounting close process:

          - Actuarial estimates of current medical liability by group size, class, and in aggregate.

          - Development of monthly financial statements, reports, and board member presentations. 

          - Formal presentation of financial condition to CEO and other Executive Staff.   

     Administration of Cross-Functional Finance and Medical staff teams:

          - Development of the Member Medical Utilization and Cost Budgets for all lines of business. 

          - Development of cross-functional reporting goals for Finance and Medical staff.  

 

DEFENSE CONTRACT AUDIT AGENCY (DCAA), U.S. DEPARTMENT OF DEFENSE (DOD)     [2004 – 2005]

• GS-9 AUDITOR                                    

     Audited civilian contractors for adherence to contractual obligations:

          - Analysis of contractor financial records to verify adherence to U.S. Purchasing regulations.

          - Formal reviews of all performance based contractual bonuses.   

     Administration of Annual and On Demand Audits by contractor and related subcontractors:

          - Trend analysis of reported expense to assess materiality and potential recovery.

          - Allocation of local and offsite audit resources to facilitate timely and effective audit completion.

     Cataloguing of findings:

          - Development of formal audit packet including all supporting evidence and research. 

          - Formal presentation of findings to government contracting officers and contractor personnel.

 

 

LEXMARK INTERNATIONAL    

[1998 – 2004]

• ANALYST-VENDOR ADMINISTRATION AND SUPPORT (2003 – 2004)

     Administration and Monitoring of vendor during implementation of offshore I.T. support facility pilot:

          - Evaluate vendor processes for call queue management.

          - Evaluate the overall status of the pilot project weekly and develop recommendations for project plan adjustment.

     Coordination of Technical Training:

          - Analyze and rate the technical proficiency of vendor I.T. support personnel.

          - Development of procedural manuals detailing step by step solutions for common technical issues.

 

• TECHNICAL SUPPORT REPRESENTATIVE (1998 – 2003)

     Software and Network Support of Lexmark business customers and clients:

          - Support Lexmark products at remote client locations with EVERY commercially available operating system and network.

          - Remotely guide network administrator at client locations through network (TCP/IP generally) setup, design, and repair. 

          - Remotely guide I.T. staff at client locations through driver/software installation, migration, setup, and repair.         

     Administration of Support of Projects requiring longer term escalation and testing:

          - Coordinate inter-departmental testing with software programmers in order to develop or adjust proprietary software.     

          - Directly coordinate or monitor large scale reinstallations and migrations with business clients.    

     Departmental Trainer:

          - Tasked with periodically developing and conducting training programs for various departmental operational activities. 

 

 

U.S. NAVY    

[1994 – 1996]

• TRANSIENT PERSONNEL UNIT, U.S. NAVAL STATION NORFOLK (1995 – 1996)

     Office Staff Supervisor

          - Coordinate production and delivery of daily facility wide reports.

          - Supervision and Scheduling of office staff. 

          - Successfully maintained service levels despite a variable staffing level; “Transient” sailors were subject to transfer daily.                           

 

• USS KALAMAZOO (1994 – 1995)

     Manager of the Chief’s Mess

          - Coordinate all meal planning, preparation, delivery, and cleanup for the 40 highest ranking enlisted personnel on board.

          - Supervision and scheduling of Chief’s Mess staff sailors.    

 

 

 

 

 

 

 

 

EDUCATION HIGHLIGHTS:

 

GRADUATE

• MASTERS DEGREE IN ACCOUNTING

     University of Kentucky

          - 3.90 Graduate G.P.A.

          - Perfect Score on Masters’ Thesis.

 

UNDER-GRADUATE

• BACHELORS DEGREE IN FINANCE AND ACCOUNTING (DOUBLE MAJOR)

     University of Kentucky

          - 3.72 Undergraduate G.P.A.

          - Magna Cum Laude with Departmental honors (Finance).

          - Beta Gamma Sigma Academic Honor Society (Accounting).

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