Jessica Smith has over fifteen years of experience as a leading expert on healthcare policy and risk adjustment knowledge, bridging the gaps between Medicare, Medicaid, and commercial risk adjustment.
Ms. Smith has experience developing corporate strategies and initiatives that adapt to policy changes. She provides end-to-end support for risk adjustment operations, data management, and value-based payments.
Ms. Smith has led health plan efforts to implement commercial risk adjustment operations and technical support. She has been instrumental in restructuring risk adjustment to become more of an enterprise-wide function. She has held positions of accountability for Medicare Advantage risk adjustment operations and data submissions. Her responsibilities have included vendor selection and oversight, analytical specifications for interventions such as retrospective and prospective, provider education, data integrity and reconciliation for data submissions, and RADV (Risk Adjustment Data Validation) audit processes. She was also a cofounder and chief strategy officer of a healthcare software company that focused on the development of applications to support value-based services, data management, and chart storage.
In addition to health plan and vendor positions held, Ms. Smith provides industry insights through conference presentations, webinars, cowriting white papers, and general advisory services. For almost two decades, she has focused on public-private healthcare market interactions in the context of ongoing analysis of key financial and public policy trends as they impact profitability and compliance processes in the industry. She is passionate about the healthcare industry and delivering quality care to all members.
Cofounder/Chief strategy officer
Gorman Health Group
Senior vice president, Healthcare Analytics & Risk Adjustment Solutions
Blue Cross Blue Shield of Minnesota
Director, Risk Management
Finance manager – Medicaid
WellCare Health Plans
Senior financial analyst
Girl Scouts of America
Areas of Expertise
University of South Florida