SHWETA PALAKKODE

**** ******** ******, ****** ****, MO-64110

314-***-****

acwanz@r.postjobfree.com

EDUCATION

University of Missouri-Kansas City Bachelor of Health Sciences (May of 2015)

PROFESSIONAL EXPERIENCE

Human Arc

Medicaid Eligibility Specialist (Patient Account Representative) September 2015 – current

Function as liaison between state and client on Medicaid claims; main point of contact for clients and state case workers

Perform deficiency analysis and pursue revenue opportunities. Gather, analyze and implement data/knowledge to recover best initiatives for cases

Investigate, evaluate, negotiate and reimburse on Medicaid claims and successfully secure Medicaid on multi-million dollar cases thus bringing success financially and operationally

Individually exceeded productivity goals by 125%, recovered revenue for the team by over $250,000 in less than a quarter since stepping in to the role ensuring excellence beyond predicted service and financial forecasting

Screen uninsured/under-insured self-pay members for potential Medicaid programs, work cases til final state decision furthermore take critical action steps based on state decision while having the best interest for members

Assisted with development, testing and maintenance of a successful business model viz transitioning from paper processes to paperless bedside assistance which has led to increased efficiency, revenue and client satisfaction

Problem solve, think critically and address issues logically and consistently; help clients make informed decisions in an ethical and zealous manner

Negotiate coverage plans with the state of Missouri and Kansas to recover best reimbursements for members; identify third party coverage plans and recognize any issues with billing

Make necessary collateral contacts to obtain verification for processing the claim, review documentation and verifications for accuracy and correctness prior to submission to the state further on identify issues in project, billing or other areas related to revenue reimbursements

Create and compose strong cases for state hearings and function it with the Missouri and Kansas Hearing Unit in conjunction with administrative law judge, state case worker and claimant (client)

Build and maintain relationships by handling a high volume of inbound/outbound calls; respond to electronic/in-person inquiry from the state, members, insurance companies and other internal and external stakeholders

Run & produce weekly reports on client status, YTD goals, approvals and revenue

Facilitate meetings on high dollar/high risk meetings and present up to date case updates on possible solutions with the help of charts, graphs, pivot tables etc.

Interpret, comprehend and communicate complex state/federal benefits( Medicare, Social Security benefits etc.) to members in a clear and concise manner

Research laws and policies pertaining to state and federal benefits and analyze cases and take appropriate actions steps based on best practices, legal research and best judgments. Provide clear and concise verbal and/or written documentations of results that supports case conclusions

Health Information management(HIM) of respective client electronic medical records(EMR) ensure compliance with HIPAA and HITECH policies

Working and functional knowledge of Epic system

City of Kansas City Health Department January 2015 – May 2015

Community Organizing Intern

Supported with $100,000 state of Missouri funded “HEAL” Grant quality improvement project to promote healthy living; ensured financial and operational success for local business as well communities

Collaborated with internal/external stakeholders and business subject matter experts to create interventions for urban business in food desert neighborhoods through identifying, evaluating, and managing change process and quality improvement

Assisted with business development by designing intervention plans, conducted analysis on improving business processes based on business needs and ensured implementation is logical, consistent and in context

Collaborated with the Kansas City Health Department staff to educate and certify local childcare centers in the Kansas City metro area to meet “Move Smart” program requirement

Communities Creating Opportunities May 2014 – December 2014

Fellowship/Internship

Developed a Kansas City Resource Guide for the homeless population, economically deprived, children, urban immigrants various & other special-needs population

Collaborated with local communities and managed a voter enrollment projects for midterm elections

Conducted a stakeholder analysis between Minnesota Heath Department and City of Kansas City Health Department

UMKC Residential Life

Resident Advisor August 2013 – May 2015

Supervised a University Residence Hall floor of 40 ethnically diverse undergraduate students

On-call duties twice a week and being the first respondent to emergencies

Ensured compliance of university and residential Life policies/regulations by residents and take necessary disciplinary actions on violations

Conducted floor meetings and frequent drop-ins to discuss events and addressed academic/personal concerns to ensure students are directed on the right path

Have 1:1 meetings with residents, monitor and evaluate their overall-wellbeing, if quality of well-being is compromised discuss with residents possible intervention steps based on their needs that best fit their lifestyle

Planned and executed floor programs thrice a month to help residents succeed academically and socially

Resolved all conflicts ranging from interpersonal disputes to alcohol/drug violations

Front Desk Assistant August 2012 – May 2015

Lead trainer for incoming staff

Monitored all individuals entering the residence halls, checked in and out residents/ guests

Maintained resident roster, incident reports and ensured reporting of critical incidents to appropriate authority in a timely manner

UMKC Henry W. Bloch School of Management August 2013 – December 2014

Professional Student Assistant

Provided Customer Service for inbound and outbound callers and walk-in clients

Scheduled meetings and appointments for faculty/staff and run daily reports

Created student file and organized student records

Preserved confidentiality of student information and complied to all confidentially processes

SKILLS and AWARDS

Written recognitions from clients and team leads and also determined as “A” player on performance review with Human Arc

Awarded as the Employee of the Year 2013 with Residential Life, Awarded Desk Assistant of the Month(twice) with Residential Life

Strong interpersonal, presentation, training, research and grant writing skills

Display very strong work ethic and can manage priorities/tasks without supervision

High level understanding and functionality of HER systems (Epic System, Human Arc Compass), Meaningful Use, ICD 9/10, HIPAA, HITECH, HIMMS, HIE etc.

Hold an extensive knowledge of federal (Social Security and Medicare ) programs as well as various current healthcare policies

Demonstrate excellence in analytical and problem solving skills and can work well in high pressure environment

Advanced expertise in various Kansas and Missouri state programs such as MO Health Net for Aged, Blind and Disabled(MHABD), Spend Down Programs, Ticket to Work Programs(TWH), Medicaid for Pregnant Women(MPW), Medicaid for Families(MAF), MO Healthnet for Kids(MHK), Children Health Insurance Programs(CHIP), Medicare Cost Saving Programs such as QMB, SLMB 1 and 2 programs, Emergency Medicaid for non-citizens, medically needy, SOBRA programs, high level interpretation of Medicaid Eligibility(ME)codes

Certified in level 1 and level 2 customer service

Strong with Microsoft Office Suite- Word, Excel, PowerPoint, Publisher; Oracle, Taleo, PeopleSoft, Insite

VOLUNTEER EXPERIENCE

Research Assistant- Mid-America ATTC June 2014 - August 2014

Research Assistant/Data Collection- UMKC Fall Prevention in Seniors January 2014 – May 2014

Safety Street Intern- Kansas City Health Department September 2013 – December 2013

Pantry Organizer- New House Women’s Shelter April 2012-August 2013

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