Heather M. Email & Phone Number

Honolulu, Hawaii, United States

• Current Project: Hawai’i Med-QUESTRole: Medicaid Eligibility Business Analyst
• Work closely with team leads within the Business Process Redesign and Systems workstreams.
• Develop business requirements and consult on the design and functionality for system enhancements, defects, and system modifications.
• Engaged in redesigning the business process for the systems release life cycle.
• Serve as a subject matter expert in Medicaid and eligibility systems to develop and review job aids, standard operating procedures, and policy clarifications for Med-QUEST staff.
• Act as the systems workstream liaison to capture action items, provide updates, and consult on deliverables.

• Managed and monitored client financials to ensure compliance with program policies and reporting requirements.
• Served as subject matter expert in federal and state benefit programs, procedures, policies, and regulations – leveraged knowledge to optimize internal policy and procedures.
• Assessed clients against key requirements to generate program eligibility profiles.
• Conducted ongoing monitoring of eligibility profiles to minimize risks to coverage and maximize on client coverage opportunities.
• Prepared documentation on behalf of clients for the purpose of program enrollment and continuity of benefits.
• Researched, prepared, and prosecuted administrative appeals for benefit denial and disagreements on behalf of the Public Fiduciary clients.

Harrisburg, Pennsylvania Area

• Served as an expert subject matter team member to assist in facilitating regulatory compliance in product phasing through user acceptance testing and evidencing practices.
• Monitored and evaluated ongoing federal policy directives to ensure state-wide Medicaid program implementations remained in compliance.
• Directed and authored correspondence with state-wide Assistance Offices advising appropriate corrective actions by translating and clarifying policy and procedures to spearhead specific and generalized obstacles.
• Established program eligibility rules, outreach and enrollment strategies, and participated in efforts to maximize suitable and fiscally responsible care that ensured positive health outcomes for vulnerable and needy.
• Collaborated and coordinated with various social services and product development teams to conceptualize enhancements to product design, development, and management.
• Remodeled and standardized state-wide policy and procedure handbooks used to determine eligibility for Medicaid programs.

• Department of Human Services for the State of PennsylvaniaIncome Maintenance Caseworker Supervisor / 1 year, 6 months
• Managed, provided guidance, and leadership for a team of up to 10 income maintenance caseworkers regarding the policies and procedures for determining eligibility of social services, interviewing clients, time.
• Conducted weekly conferences with subordinates to review policy, procedures, problem solving counseling, quality control counseling, provided feedback, assessed work habits, and pioneered customized training materials.
• Administered trainings to all staff on innovative programs, policies, and procedures from directives implemented by the Department of Human Services.
• Advised management of performance deviations and consulted with management on corrective actions.
• Examined client case records to ensure caseworkers were meeting high standards by properly applying policies and procedures, actions, and decisions related to all federal and state social services.

Thorndale, PA

• Created, maintained, processed, and managed large caseloads from initial applications to ongoing case management for eligibility determination.
• Attained high performance standards for accuracy, proficiency, timeliness, and customer service.
• Analyzed client case records to ensure that clients attained and maintained compliance with all state and federal regulations.
• Collaborated with various local agencies to provide clients with all available resources to attain self-sufficiency.
• Assisted with conducting investigations into potential fraudulent cases.
• Screened potential social service applicants through a detailed interview process.

Bachelor Of Arts (B.A.), Anthropology

Activities and Societies: Anthropology AssociationB.A. Anthropology with a strong focus on Archaeology and Bioanthropological Methods

Associate'S Degree, Applied Sciences

Activities and Societies: Phi Theta KappaA.S. Applied Science

Field School, Zooarchaeology And Field Ecology, A

Activities and Societies: Area of Study: Foraging theory, prey choice, the nature of the archaeofaunal record, units of quantification.