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Skills

  • Insurance billing
  • Generally Accepted Accounting Principles (GAAP)
  • Client relationship management
  • Communication of policy updates
  • Financial planning
  • Case auditing and review
  • Interest calculations
  • Year-end reporting
  • MS Office
  • Auditing proficiency

Work Experiences

  • Saved money by developing functional solutions to metric problems.
  • Kept track of historical documents by microfilming and filing them.
  • Acquired certification in ITIL.
  • Cut operating costs by $5 per year by partnering with cost-effective vendors.
  • Working with team members and customers to find workable solutions improved operations.
  • Achieved a 73% reduction in overdue cases.
  • Achieved Employee of the Year for exceeding monthly goals.
  • Kept my process knowledge up to date by doing process improvement and risk assessment.
  • Was in charge of all tasks delegated to me, including vendor management and workflow optimization.
  • Answered 18 phone calls per several months to assist customers.

Summaries

  • Medicaid Representative has been recognized for successfully batching, posting, and matching over 6 invoices on a daily basis.
  • Expert in category with a strong aptitude for optimized and automated.
  • Exceptional at juggling multiple goals in order to maximize efficiency and influence positive outcomes.
  • Ability to recognize initiative issues and integrate process solutions to achieve system.
  • With 4 years of functional experience in providing clerical, administrative, and financial services, I am dependable and professional.
  • Medicaid Representative offerings that are meticulous 5 years of comprehensive experience in Miscellaneous.
  • Medicaid Representative expert with 9 years of experience.
  • Astute accountant with experience analyzing data to find cost-cutting and process-improvement opportunities.
  • Team leadership in procedure settings and quality assurance in client relations settings.
  • Student pursuing a Miscellaneous degree who is eager to contribute developed knowledge in the role of Medicaid Representative.

Accomplishments

  • Developed a Medicaid client communication strategy, improving outreach efficiency and meeting state compliance deadlines by 63%.
  • Partnered effectively with external agencies to resolve complex Medicaid documentation issues, achieving a 78% success rate.
  • Collaborated with cross-departmental teams to enhance the compliance auditing process for Medicaid services, ensuring alignment with state and federal regulations.
  • Developed comprehensive training materials for team members, ensuring that all staff met new Medicaid compliance guidelines after 2024 regulations update.
  • Utilized advanced data analysis tools like Tableau to identify discrepancies in Medicaid claims submission, leading to a 77% increase in accuracy.
  • Implemented a new digital intake for Medicaid applications, decreasing processing time by 51% and improving approval speed.
  • Researched regional Medicaid laws, integrating updates into department workflows and improving compliance audit success rates by 71%.
  • Improved data security for Medicaid processing by ensuring compliance with PMP, reducing client information breaches to zero.
  • Advised hospital administration on Medicaid-related billing practices, reducing overdue claims by 36% within 3 months.
  • Assisted patients with Medicaid enrollment, explaining eligibility criteria and helping 8% of applicants successfully navigate the application process.

Affiliations

  • Active participant in the National Association of Community Health Centers (NACHC) forums discussing Medicaid funding challenges and solutions.
  • Active in the National Health Care Anti-Fraud Association (NHCAA), attending workshops on reducing fraud in Medicaid case management.
  • Affiliated with the National Medicaid Congress, contributing to workshops on improving enrollment strategies and reducing case backlogs in 2016.
  • Volunteered for community outreach efforts coordinated by program, targeting Medicaid-eligible populations for enrollment.
  • Part of the National Association of Medicaid Directors (NAMD), regularly attending conferences on Medicaid case management best practices.
  • Completed a certified course in Medicaid & Medicare billing from Northwind, specialized in claim processing and regulatory compliance.
  • Conducted training seminars on Medicaid billing regulations with standard, facilitating improved staff knowledge and compliance adherence.
  • Member of the Society of Government Service Professionals, specializing in process optimization of Medicare and Medicaid systems for increased productivity.
  • Affiliation with the Center on Budget and Policy Priorities, where I contributed insights on Medicaid coverage expansion campaigns.
  • Regular attendee of the Medicaid Leadership Institute, engaging with thought leaders to improve community outreach and case management efficiency.

Certifications

  • Salesforce
  • Certified in Public Health (CPH) by NBPHE
  • Medicaid Eligibility Worker Certification
  • Certified Healthcare Financial Professional (CHFP) by procedure
  • Certified HIPAA Professional (CHP)
  • Apple Certified Associate (ACA)
  • Health Insurance Portability and Accountability Act (HIPAA) Privacy Training
  • Legal and Ethical Standards Training in Medicaid by Ironclad Systems 2015
  • ServSafe
  • Certified Patient Account Representative (CPAR)

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