Experience

Alabama Medicaid Agency

• Insurance
• 100 - 200 Employee

• Medicaid Eligibility Assistant Manager

  • Apr 2015 - Present

  Gadsden, Alabama Area *Assisted the District Manager in all areas of operation of the District Office including: caseload oversight, staff training, NVRA compliance, performance monitoring and continuous improvement *Served as NVRA Coordinator for Northeast Alabama District Office *Supervised, monitored and evaluated job performance of staff in the Medicaid Eligibility Program Unit *Monitored and evaluated employee job performance of assigned staff through observation and case file review. *Determined… Show more *Assisted the District Manager in all areas of operation of the District Office including: caseload oversight, staff training, NVRA compliance, performance monitoring and continuous improvement *Served as NVRA Coordinator for Northeast Alabama District Office *Supervised, monitored and evaluated job performance of staff in the Medicaid Eligibility Program Unit *Monitored and evaluated employee job performance of assigned staff through observation and case file review. *Determined initial and ongoing financial eligibility determination for institutional cases *Determined operational budget and negotiated supply orders and supplier contracts for District Office

• Medicaid Eligibility Specialist, Sr

  • Oct 2012 - Mar 2015

  Gadsden, Alabama Area * Monitored and evaluated operational procedures for the HCBS waiver programs to assure the operating agency was performing within compliance of Medicaid Established Regulatory Requirements *Performed review of medical records for case management, direct service providers, retrospective admissions, and redetermination applications to assure guidelines were followed *Established and maintained liaison relationships with agency staff, case managers and direct service providers to enhance… Show more * Monitored and evaluated operational procedures for the HCBS waiver programs to assure the operating agency was performing within compliance of Medicaid Established Regulatory Requirements *Performed review of medical records for case management, direct service providers, retrospective admissions, and redetermination applications to assure guidelines were followed *Established and maintained liaison relationships with agency staff, case managers and direct service providers to enhance communication, workflow and continuous improvement *Processed applications for nursing home Medicaid, SSI-related programs, and Home & Community- based waiver programs. *Identified patterns, trends, billing issues and quality concerns to determine the need for additional review and plan of correction *Established and maintain case files in the appropriate manner. *Provided required reports within established time frames.

• Medicaid Eligibility Specialist

  • Jun 2011 - Oct 2012

  Gadsden, Alabama Area *Responsible for determining the initial and renewal eligibility for Medicaid recipients in Family Certification *Establish and maintain case files in the appropriate manner. *Provide required reports within established time frames.



Disability Determinations

• United States
• 1 - 100 Employee

• Disability Specialist

  • Jun 2008 - Jun 2011

  Birmingham, Alabama Area Responsible for the accurate and timely processing of disability claims. * Make phone contacts to verify personal, medical, and work history information. * Responsible for requesting medical records and/or placing orders for consultative examinations. * Determine the claimant’s physical or mental capabilities. * Based on their determined level of functioning, apply Social Security vocational rules to determine the claimant’s ability to perform past work or other… Show more Responsible for the accurate and timely processing of disability claims. * Make phone contacts to verify personal, medical, and work history information. * Responsible for requesting medical records and/or placing orders for consultative examinations. * Determine the claimant’s physical or mental capabilities. * Based on their determined level of functioning, apply Social Security vocational rules to determine the claimant’s ability to perform past work or other work. Received the Rookie Disability Examiner of the Year. Show less