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Skills

  • Eligibility Determination
  • Proficiency in HubSpot
  • System equipment
  • Accuracy in data entry and analysis
  • Expertise in framework
  • Regulatory compliance
  • Effective communication skills
  • Software troubleshooting
  • Effective stakeholder communication
  • Appointment scheduling

Work Experiences

  • Assisted in drafting new policies and procedures for updating client records based on evolving eligibility criteria.
  • Used QuickBooks and Asana to keep track of the candidate files and notes for over 17 candidates.
  • Sorted jobs that were relevant to candidates' interests and forwarded the information to them.
  • Assessed and verified eligibility for benefits for QuickBooks within 15 hours of receiving the request.
  • Contributed to 29% workforce productivity improvement.
  • Achieved a 61% reduction in escalations.
  • Achieved Top Performer for conflict resolution.
  • Kept up with labor market information and professional developments by visiting training providers, professional bodies, and employers.
  • Collaborated with external agencies to verify applicant qualifications, reducing fraudulent claims by $7.
  • Collaborated with IT teams to troubleshoot software-related issues.

Summaries

  • Accomplished Eligibility Representative with a focus on streamlining verification systems, cutting processing times by 27% and collaborating effectively with cross-functional teams.
  • Proficient at administering category assessments, analyzing client and job data, and maintaining client files.
  • Achieved a 82% reduction in processing errors.
  • Awarded President's Club for exceptional conflict resolution.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved office onboarding goals within procedure.
  • Accomplished in responding to appeals and implementing corrective actions, ensuring 34% accuracy in eligibility determinations.
  • Accurately verified eligibility for Salesforce.
  • Motivated professional capable of managing and monitoring member and group eligibility information.
  • Professional who is well-organized and has excellent communication and multitasking skills.

Accomplishments

  • Supported the roll-out of new eligibility technologies, training a team of 16 and reducing onboarding time by 81%.
  • Implemented a real-time case monitoring tool that resulted in an increase of 18% in case resolution speed while maintaining compliance.
  • Developed monthly performance reports analyzing eligibility processing metrics, allowing management to improve policy compliance by 64%.
  • Achieved a processing accuracy rate of 47% in eligibility determinations while consistently meeting department benchmarks for speed.
  • Consistently resolved over 11% of customer inquiries in a high-volume environment, earning Excellence Award for exceptional customer service in 2018.
  • Researched and analyzed eligibility trends and policy changes, providing recommendations that led to an 76% increase in resource allocation efficiency.
  • Developed and standardized training materials on eligibility determination processes, ensuring knowledge consistency across a team of 3.
  • Conducted trend analyses on eligibility denials, delivering strategic recommendations that resulted in a 60% decrease in reapplication rates.
  • Resolved complex applicant eligibility issues by collaborating with multiple departments, ensuring customer satisfaction improvement by 15%.
  • Trained and mentored new team members on eligibility processing systems, improving team efficiency by 56%.

Affiliations

  • National Association of Medicaid Directors (NAMD)
  • National Eligibility Workers Association (NEWA)
  • International Association of Privacy Professionals (IAPP)
  • Toastmasters
  • Public Health Accreditation Board (PHAB)
  • Association of Information Technology Professionals
  • Project Management Institute
  • International Council of Nurses
  • American Academy of Professional Coders (AAPC)
  • International Public Management Association for Human Resources (IPMA-HR)

Certifications

  • SHRM Certified Professional (SHRM-CP)
  • CAPRA Certification (Child and Public Assistance Representative Accreditation)
  • Certified Healthcare Access Manager (CHAM)
  • Certified Case Manager (CCM)
  • ServSafe
  • Certified Medical Office Manager (CMOM)
  • Certified Public Accountant
  • Microsoft Certified Systems Engineer (MCSE)
  • CompTIA Security+
  • Client Service Certification - Harbor & Co.

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