Medicaid Eligibility Specialist(current)
Resume:
SHWETA PALAKKODE
**** ******** ******, ****** ****, MO-64110
******@*****.***
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
Contact this candidate