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Skills

  • Data entry accuracy and management
  • Insurance industry experience
  • Medicaid Application Processing
  • Advanced knowledge of state Medicaid regulations
  • Medicaid recertification workflows
  • Budgets
  • Operational improvement
  • Training program development
  • Electronic Health Records (EHR) management
  • Communications

Work Experiences

  • Collaborated with billing and finance teams.
  • Achieved this over 18 months.
  • Chaired a working group on Medicaid policy updates.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Advised clinical teams on Medicaid policy changes.
  • Advocated for patients.
  • Solved framework issues, improved operations, and provided excellent customer service.
  • Had an excellent attendance record and was always on time for work.
  • Achieved results over a one year period.
  • Collaborated with billing and finance teams to reconcile Medicaid funds and reduce outstanding balances by $18.

Summaries

  • Accomplished Medicaid Coordinator.
  • Dedicated Insurance Clerk with strong math and communication skills.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Aligned service offerings with Medicaid coverage.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to framework regulations and program department guidelines.
  • Certified in PMP, with specialization in Medicaid eligibility determination and communication strategies that have enhanced client outcomes by 66%. Customer-focused problem solver.
  • Excellent communication and computer skills, as well as a thorough understanding of category insurance policies.
  • Insurance Clerk with a track record of organization, customer service, and professionalism.
  • Analyzed quarterly reports for leadership.
  • Within Miscellaneous, senior Medicaid Coordinator and outstanding performer in workflow optimization and vendor management.

Accomplishments

  • Decreased Medicaid-related patient complaints by 17% by improving communication protocols and updating case management systems.
  • Developed and enforced Medicaid compliance strategies across 9 departments, resulting in successful audit outcomes.
  • Verified patient income and eligibility documents, achieving an 61% approval rate with minimal appeals over the past year.
  • Collaborated with case managers to resolve 15 complex Medicaid eligibility issues in two years, improving patient retention.
  • Identified discrepancies in Medicaid claims leading to a recovery of 16 in overpayments, mitigating financial risk.
  • Improved coordination between healthcare providers and billing, reducing Medicaid claims rejections by 60%.
  • Documented and resolved procedure which led to metric.
  • Developed a cross-functional communication strategy that streamlined Medicaid application reviews, reducing approval timelines by 69%.
  • Organized outreach initiatives that improved Medicaid enrollment rates by 25% in targeted demographics.
  • Managed a caseload of 11 clients, ensuring all Medicaid applications met strict deadlines and compliance requirements.

Affiliations

  • American Association of Healthcare Administrative Management (AAHAM)
  • Member of the Society for Medicaid Planning and Elder Law
  • Lions Club
  • National Association of Social Workers
  • Medicare Rights Center Professional Member
  • American Medical Informatics Association
  • Joined the Public Health Learning Network focused on Medicaid policy training
  • Partnership initiative with local Texas Department of Health Services
  • American Public Health Association (APHA)
  • Association of Information Technology Professionals

Certifications

  • Medical Billing & Coding Certification (MBCC)
  • Health Insurance Specialist Certification (HISC)
  • ServSafe
  • Microsoft Certified Systems Engineer (MCSE)
  • SHRM Certified Professional (SHRM-CP)
  • Healthcare Reimbursement Specialist (HRS)
  • Revenue Cycle Analyst Certification (RCAC)
  • Certified Medicaid Eligibility Professional (CMEP)
  • CompTIA Network+
  • Certified Public Accountant (CPA)

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