Tracy Cloud Email & Phone Number

Columbus, Ohio, Us

Columbus, Ohio, Us

• Responsible for Operations including Member and Provider Call Centers, Credentialing, Provider Data & Analytics, Claims Support, Contract Configuration, Member Experience and Transportation Vendor Management • Led operational implementation of statewide Medicaid expansion, MyCare Ohio (duals) and Health Insurance Marketplace Product.• Set strategic direction for member satisfaction (CAHPS); rated top tier by NCQA for Medicaid Consumer Experience in 2015• Operationalized rapid network growth; tripling the provider network in three years while transitioning to a new provider data system.

Columbus, Ohio, Us

• Responsible for Medicaid operations; identified and implemented operational efficiencies related to call center, claims and eligibility• Provided business expertise and leadership in the development, enhancement and maintenance of 10 web-based systems which govern Medicaid waiver enrollment, individual data, provider certification, cost projection, authorization and claims payment of Medicaid waiver services• Led a team of subject matter experts and worked directly with IT to develop the Medicaid Services System which has over 3,500 users, projects costs for 24,000 waiver recipients and authorizes over a billion dollars in costs per year• Communicated policy, operational and system changes to the DD field; frequently presented at stakeholder meetings and conferences• Led a workgroup comprised of various stakeholders to develop a new waiver service and rate model targeted to providers who serve their adult children or other relatives

Columbus, Ohio, Us

• Analyzed, formulated and implemented Ohio Medicaid payment policy for hospital services which involve rate setting and maintenance of the DRG based hospital reimbursement system• Managed the disproportionate share program and other reimbursement programs which distribute over $500 million state and federal dollars to Ohio hospitals• Ensured program compliance with state and federal regulations and CMS state plan approval of Ohio Medicaid hospital reimbursement methodology• Project managed NPI implementation, rate updates, provider enrollment, claims adjustments, and changes in reimbursement methodology• Prepared and edited policy analysis, budgetary impact statements, legal notices, federal rate notices, Ohio Administrative Code amendments and memos to members of the Ohio General Assembly pertaining to hospital reimbursement policy

Columbus, Ohio, Us

• Developed policy and filed administrative rules pertaining to laboratory, home health, ASC and ambulance providers• Communicated policy and billing instructions to providers, trade associations, county agencies and internal staff • Worked with IT to implement reimbursement policy in the claims payment system and trouble shoot problem claims

Supervised a unit of nine case managers who determined eligibility for Medicaid and each maintained caseloads of over 400 Medicaid cases.Managed workflow and cut the unit’s number of delinquent cases by 80%, prepared and analyzed reports compiled from caseload data.Handled problem cases and customer service complaints; headed a committee that set customer service and case processing standards for the agency.Hired and trained staff, reviewed cases, completed employee reviews and utilized progressive discipline when necessary.

Determined eligibility for Medicaid and other public assistance programs; maintained a caseload of 450.Assessed and assigned clients to appropriate work or training activities. Assisted clients in the transition to self-sufficiency.

M.P.A., Public Policy And Management

B.A., Political Science And Psychology