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Sherly Smith
Open to opportunitiesSenior Compliance Professional
I improve healthcare compliance, CMS readiness, and post-discharge care coordination at Humana.
United StatesSenior Compliance Professional at Humana Inc.
About
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
Senior Compliance Professional
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.
Compliance SupportMedical CodingAudit PreparationPowerPointWordOutlookTeams
UM Administration Coordinator 2
Provided administrative support across utilization management workflows, ensuring appropriate member services. Interpreted department policy and exercised discretion to prioritize care support needs.
Utilization ManagementMember ServicesDocumentation
Education
Florida International University
Bachelor of Science in Hospitality Management from Florida International University.
Johnson & Wales University
Associate of Science in Travel, Tourism & Hospitality from Johnson & Wales University.