Heather M. Email & Phone Number

Chattanooga, Tn, Us

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. • Assist in various UAT activities including developing user-friendly technical translations, writing scripts, testing, and reporting results to the client and vendor. • Develop training materials for our internal team to train Medicaid policy and Hawaii’s MES/MMIS systems (KOLEA). • Support in facilitating client and vendor meetings as a policy and eligibility systems subject matter expert.• Continue to provide recommendations based on ongoing gap analysis, client feedback, and using best practices.

• 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. • Maintained time records and billed client estates for rendering of professional services.

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 populations. • 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 management, and reviewing and updating case records. • 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. • Facilitated annual employee performance reviews in accordance with guideline directives from the executive director by evaluating and discussing strengths and weaknesses and recommending any changes to improve overall office performances while mitigating risk.

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.• Consistently met and exceeded office standards, demonstrated leadership capabilities, and attained a reputation for reliable, consistent, and outstanding work.

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.