Managing Ombudsman over the HHSC Ombudsman Complaint Services Call Center. The HHSC Ombudsman’s Office is a 3rd party state agency that assists clients under all sections of state agencies and benefits with resolving issues and complaints if they have not been able to do so with the regular processes.

Subject Matter Expert (SME) for Pharmacy and Medical billing/adjudication of Medicaid Managed Care Claims and encounters.•Ensure the proper implantation of initiatives, policies, and programs.•Monitor and track Managed Care Encounters (Claims), establishes program priorities for achieving operational goals of the state Medicaid agency, as well as coordinating and evaluating ongoing operational activities and system compliance.•Review Medicaid Claims Administrator implementation deliverables and identified, communicate, and address trends in Pharmacy and Medical billing issues.•Addresses client and provider complaints with HHSC and the Managed Care Plans•Manage projects that require an information technology SME providing highly advanced consultative, technical assistance, and guidance to the Medicaid program area related to Medical and Pharmacy claims adjudications, payment of claims, and operationalization of policies and program rules.•Performs highly technical customer service, public information, and follow-up activities for the Medicaid (traditional and Managed Care)•Coordinate between clients, providers, and contractors to make determinations and resolve problems and issues. Analyst aids in the development, review, or maintenance of the Texas Medicaid Provider Procedures Manual and other internal and external documents.•Experience in handling multiple responsibilities while meeting competing deadlines participating in workgroups, public meetings regarding acute care program and policy issues, initiatives, and Medicaid program changes, and participates in special investigations, studies, and program analysis projects.•Maintain and promote positive open-door communication with all vendors and third parties.

Oversees the Medicaid/CHIP Vendor Drug Pharmacy (VDP) Billing Help Desk.•Supervisor to appx. 30 HD staff who work in a call center that assist pharmacy and providers with pharmacy electronic claims Management systems billing issues and assistance for Medicaid/CHIP, pharmacy billing issues, overrides, prior authorizations and other pharmacy-related issues. •Train, lead, assign and/or prioritize the work of help desk staff, identify training needs of staff and pharmacies, develop and deliver training to staff and pharmacies. Develop resource tools for staff and pharmacies. A liaison for Medicaid/CHIP pharmacy that works with other agencies and programs to identify, research and address pharmacy access to care issues. This includes pharmacy legislative complaints, provider complaints, and client complaints that are pharmacy related. Provide performance reviews, scheduling, approve time and leave. •Understand the Medicaid/CHIP Pharmacy billing and statutory requirements. Provide consultative services and oversight of the planning, implementation, and monitoring of programs and services related to Pharmacy Benefits. Plan, develop and implement Medicaid/CHIP pharmacy programs. Develop policies, guidelines, procedures, and communications internal and external. Identify and report compliance with program policies and procedures, statutes, and rules. •Collaborates with HHSC staff, vendors, external associations, and other state agencies, governmental agencies, contracted providers, managed care plans, pharmacy benefit managers, contractors, community organizations, and the general public toward the timely resolution of issues, the identification of trends, the development of recommendations for improvement and the resolution of operational problems. Analyze federal and state legislation and oversight agency regulations relating to the VDP to estimate the impact and help develop agency responses to proposed changes.

Head of Social Security Disability Recipients Food Stamp Program for the entire state of Texas and oversees multiple special projects for the Centralized Benefits Special Services Department.•The lead of 20 program staff•Subject Matter Expert (SME) for a specialized program for food stamp clients on a fixed social security income across Texas.•Special projects consist of addressing program complaints from clients, alerts, and reports of food stamp fraud sent by the Office of Inspector General and Ombudsman's Office with the highest level of importance.•Investigate reports of fraud complaints and issues reported to the Office of Inspector General (OIG) and Ombudsman's Office in conjunction to sending appropriate referrals.•Effectively interpret and communicate policies and resolution options to clients that may have cognitive issues to resolve issues and take the appropriate case action.•Determine and Re-determine client eligibility for benefits after recertification or change of case information in TIERS, SAVERR, GWS, and Auto Certification.•Specialist to convert food stamp cases from the old SAVERR ("DOS" System) to the new TIERS ("Gooey" System) and verify results.•Complete searches through the Office of Attorney General for child support payments/income, complete criminal background and asset checks on clients for caseworkers.•Case read cases for staff for potential case errors, review case supplements (additional or back funds) to ensure they are valid supplements. Process overpayment recoupments, manual supplements, the system issued supplements, and restores benefits. Identify and correct case errors or case discrepancies.•Documented each case action or inquiry to establish a record of each client's case status and history. Maintained a consistent work schedule and communicates effectively with internal and external customers.

MHMR Supervisor (PNA IV) for a psychiatric hospital in a unit that holds up to 23 men and women with various forms of Mental Health. The PNA IV is always consultation with the Charge RN on duty. The PNA IV will performs supervisory tasks as needed to keep the patients environment as calm as possible. In addition they train and serve as a role model for PNA I,II & III . They are responsible for insuring the protection of the clients from abuse, neglect, exploitation, injuries & accidents. To ensure their environment is one of caring, dignity and respect. The PNA IV is responsible for specified care, training, treatment and basic residential activities of patients as assigned on a routine or crisis basis. They make sure new staff are adequately trained correctly and up to date. They are required to accurately complete documentation on patients daily. They need to be familiar with state computer programs to make computerized reports concerning patients information, vitals signs and all activities of daily living . Be familiar with admitting patients, looking up patient information using CWS computer program. Using CWS Avatar to discharge patients from hospital. They are required to effectively administer appropriate action in emergency or life treating situations or with patients who are aggressive, combative or are in need of medical attention. They are required to be in direct physical contact with patients and to closely follow infection control.

Executive Women in Texas Government (EWTG) is a non-partisan organization that promotes leadership in service to Texas by offering professional development opportunities.

IT for state vendor-supplied electronic healthcare and pharmacy applications for all State Hospitals and State Support Living Centers in Texas. Enhance and maintenance perform advanced business and systems analysis, designs, develops and maintains custom installation of software.•Monitors projects, planning project-related tasks, coordinating projects with the work of other IT units, analyze computer applications, writing programs, and giving technical assistance to programmers.•Programming including multiple files, multiple field validations, multiple screens; report formats which involve multiple data grouping and Database Connectivity (ODBC); multiple platform interfaces; nested Structured Query Language statements involving multiple related files; object-oriented programming.

Assist people with MH&MR with daily living skills and to keep their environment as normal as possible. This includes bathing, feeding, and grooming. Administering of medications, assist with training and skills programs and transportation to work shops, Dr Appt. and community outings. Ordering groceries and supplies for the home. Check all paper work to make sure all documentation is complete and submit and the end of the month for billing, to make sure all necessary paper work is available and filed. Keep track of all clients' money, making sure they have enough available cash to meet there needs for the week for all personal use, check that all sums are correct and accounted for with receipts