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Skills

  • Behavioral health and Medicaid coordination
  • Process improvement
  • Data entry accuracy
  • Process improvement strategies
  • Medicaid case analysis
  • Applicant engagement
  • Case management system expertise
  • Program knowledge
  • Client outreach and enrollment strategies
  • Effective communication skills

Work Experiences

  • Collaborated with IT teams to enhance Medicaid application portals, boosting user experience ratings by 65%.
  • Collaborated with engineering and finance to implement data integrity checks, ensuring a 100% compliance with state Medicaid regulations.
  • Collaborated with IT teams.
  • Assisted patients in navigating appeals processes, resulting in a 27% increase in successful claims overturns.
  • Collaborated with caseworkers and healthcare providers across Chicago to reduce Medicaid claim errors by $13, ensuring more timely client benefits.
  • Reviewed applications for various aid programs and determined which individuals met the eligibility requirements.
  • Boosted user experience ratings by 36%.
  • Provided re-employment services, job clubs, and job search assistance, as well as job-seeking skills training in group and individual settings.
  • Collaborated with caseworkers and healthcare providers.
  • Achieved a 19% increase in timely approvals.

Summaries

  • Achieved a 57% first review error resolution rate.
  • Collaborated cross-departmentally to establish data integrity procedures, ensuring 52% compliance with state Medicaid regulations.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Dedicated to expanding job opportunities by forging strong bonds with employers and job seekers.
  • Analyzed claims for inaccuracies.
  • Costs were consistently reduced while profits were increased.
  • Strengths in quality assurance and data analysis backed up by Miscellaneous training.
  • Achieved a 79% reduction in appeal times.
  • Proficient at administering framework assessments, analyzing client and job data, and maintaining client files.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.

Accomplishments

  • Identified and resolved potential Medicaid fraud cases, reducing fraudulent claims by 18% over three years.
  • Created a cross-departmental workflow that expedited Medicaid referrals, decreasing approval time by 16 days.
  • Collaborated with team of 11 in the development of metric.
  • Prepared detailed reports on Medicaid services, outcomes, and trends, driving policy adjustments that improved service delivery by 49%.
  • Led the deployment of new Medicaid billing software, achieving a 26% reduction in processing errors.
  • Streamlined inter-departmental communication processes that reduced query response times by 27%.
  • Implemented behavioral health integration strategies, ensuring that 19% of Medicaid clients received appropriate mental health services.
  • Collaborated with legal teams to mitigate Medicaid fraud risk, achieving a 68% reduction in compliance violations in the past year.
  • Provided subject matter expertise on Medicaid policy updates, aiding compliance teams in efficiently managing transitions.
  • Trained 9 staff members on Medicaid policy changes, leading to a 49% reduction in application errors.

Affiliations

  • American Academy of Professional Coders (AAPC)
  • Society of Human Resource Management
  • National Association of Social Workers
  • Institute for Medicaid Innovation (IMI)
  • American Marketing Association
  • Centers for Medicare & Medicaid Services (CMS) Mentor Program
  • National Council for Behavioral Health
  • Healthcare Information and Management Systems Society (HIMSS)
  • National Association for Healthcare Quality (NAHQ)
  • AcademyHealth

Certifications

  • Certified in Public Health (CPH)
  • Healthcare Data Analytics Certificate Harbor & Co.
  • Certified Health Data Analyst (CHDA)
  • CompTIA Security+
  • First Aid/CPR Certified
  • Certified Government Auditing Professional (CGAP)
  • Certified Specialist in Public Health Eligibility (CSPHE)
  • HIPAA Privacy and Security Certification
  • Certified Medicaid Planner (CMP)
  • ServSafe

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