Health Advocate (Ican)
CurrentRepresent Medicaid Managed Long Term Care (MLTC, MMC, MAP & HARP) enrollees in insurance disputes involving personal care services, Medicaid eligibility, Medicaid budgeting, nursing home discharges and durable medical equipment. Ensure compliance with all relevant Medicaid, Medicare, NYCRR, HIPAA, and Social Services Law rules and regulations. Achieve an 88% win rate and $4,500,000 won representing enrollees in hundreds of fair hearings through the Office of Temporary and Disability Assistance. Draft and file medical necessity external appeals with the New York State Department of Financial Services, achieving a 93% overturn rate and $3,000,000 won. Conduct witness preparation and questioning for fair hearings. Oversee summer internship program, including interviewing applicants, developing curriculum, and supervising interns.