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Skills

  • Effective negotiation skills
  • Trends analysis
  • Conflict resolution
  • Business operations
  • Caseload prioritization
  • Benefit disbursement accuracy
  • Process optimization
  • Implementation of Application Processing Systems
  • MS Office
  • Client interviewing techniques

Work Experiences

  • Analyzed Medicaid policies.
  • Achieved results within 9 months of implementation.
  • Analyzed Medicaid policies and applied complex regulations to ensure applicants met specific eligibility requirements in Portland.
  • Documented accurate descriptions of required job duties, working hours, and wages by writing job orders for employers.
  • Decreased case processing time by 17 days on average.
  • Achieved a 81% success rate in case resolutions.
  • Used QuickBooks and Microsoft Excel to keep track of the candidate files and notes for over 14 candidates.
  • Created and maintained thorough records in ServiceNow.
  • Analyzed rejected applications.
  • Achieved improvements in 2018.

Summaries

  • Adept at providing detailed reports and data analysis for Washington Medicaid programs, achieving a 27% increase in benefit approvals and compliance.
  • Considered a team player who excels at multitasking.
  • Supportive Eligibility Specialist with a strong commitment to customer service and extensive application engagement.
  • Employers and community organizations are contacted to identify job opportunities for clients.
  • Recognized on a regular basis for outstanding performance and contributions to the Customer Service industry's success.
  • Collaborated with partner organizations and internal staff.
  • Achieved a 70% reduction in processing errors.
  • Medicaid Eligibility Specialist with 12 years of successful budget management and quality assurance experience.
  • Achieved a 36% improvement in submission accuracy.
  • Proficient at administering system assessments, analyzing client and job data, and maintaining client files.

Accomplishments

  • Optimized documentation collection processes by implementing an online portal, reducing incomplete application submissions by 70% and improving workflow efficiency.
  • Facilitated high levels of client engagement by explaining Medicaid eligibility requirements in clear, accessible language, decreasing confusion for new applicants by 64%.
  • Trained junior staff on Medicaid application processing and compliance, resulting in a 33% accuracy increase across reviewed applications.
  • Mastered the use of case management software systems to track eligibility status changes across over 5 active Medicaid cases.
  • Collaborated with social services departments to provide comprehensive eligibility assessments, increasing program uptake by 56% within the past year.
  • Provided insights on state Medicaid regulation updates during monthly team meetings, ensuring staff remained compliant with Massachusetts guidelines.
  • Implemented a client feedback system for the Medicaid application review process, which improved overall client satisfaction by 80%.
  • Ensured compliance with HIPAA protocols when handling sensitive client information, maintaining a 41% error-free record over the past year.
  • Managed a caseload of over 18 Medicaid beneficiaries, ensuring compliance with state eligibility guidelines and improving benefit access for low-income families.
  • Effectively assisted non-English-speaking applicants, increasing equitable service delivery and improving client satisfaction by 29%.

Affiliations

  • American College of Healthcare Executives (ACHE)
  • American Medical Informatics Association
  • Professional Association of Healthcare Office Management (PAHCOM)
  • American Association of Public Welfare Attorneys (AAPWA)
  • Society for Public Health Education (SOPHE)
  • Association for Community Affiliated Plans (ACAP)
  • National Association of Professional Medicaid Specialists (NAPMS)
  • Association of Information Technology Professionals
  • Lions Club
  • International Council of Nurses

Certifications

  • Certified Medicaid Planner (CMP)
  • Google Certified Professional Cloud Architect
  • AHIMA Certified Coding Associate (CCA)
  • CompTIA Security+
  • State-Specific Certified Medicaid Eligibility Specialist (CMES) in Georgia
  • Medicaid Eligibility Quality Control Certification
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Health Insurance Specialist Training Certificate
  • SHRM Certified Professional (SHRM-CP)
  • Modern Medicaid Data Analytics Certification from metric

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