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Mrs. Smith joined our
organization in January of 2005 bringing with
her 17 years of managed care experience. She
began her managed care career with Florida 1st
Health Plans, Inc. an HMO servicing Polk,
Highlands, and Hardee Counties and a Third Party
Administrator servicing self insured groups
throughout the United States.
During her tenure
at Florida 1st, Dawn’s self motivation quickly
propelled her through the various operations of
managed care. She has held the positions of
Team Lead for the Customer Service Department,
Network Analyst, Flexible Spending Account
Processor, Claims Processor, Examiner and
Supervisor. Dawn was promoted to the
Supervisor of the Data Management Team and
supervised a staff of 13 team members
responsible for the data integrity of the
operations system. This included various
functions such as member eligibility, referrals,
authorizations, capitation risk management,
provider file, vendor file, procedural coding
maintenance (CPT, HCPCS, ICD-9), fee schedule
design and maintenance. Dawn transferred to
the Network Services Department where she
supervised a staff of 8 which maintained the
loading of provider contracts from fee schedules
to DRG pricing. This knowledge afforded her the
opportunity of promotion to Provider Contract
Specialist where she specialized in contracting
primary care, specialty, and ancillary providers
for both the HMO and TPA business. Her
responsibilities also included credentialing all
provider types, provider utilization reporting,
capitation reconciliation, and electronic claims
submission.
Currently Dawn is the Regional
Manager of Network Services contracting with Primary
Care, Specialty, and Ancillary providers and she
works closely with the Marketing Team to
coordinate events within the community. |
