Health Insurance Specialist
Dynamic, self-motivated professional with 6+ years of experience in Medicaid and Health Insurace management and services. Skilled planner and strategist with an ability to prioritize multiple projects, manage competing deadlines, and deliver results on time. Strategic and highly-organized professional who can utilize working knowledge to perform operations efficiently. Equipped with technical expertise, exceptional leadership skills, and a great ability to learn new concepts and technologies. Exceptional interpersonal and communication skills, with ability to interface and collaborate with all levels of organizations. Excellent communication skills in both English and Arabic. CORE COMPETENCIES
Project Management Health Insurance Knowledge Interpersonal Skills Leadership Team Management Skills Organizational Skills System & Software Implementation Record Management Problem Solving Skills Financial Management Analytical Skills Communication Skills TECHNICAL SKILLS
Cisco WebEx Teradata MS SQL IEDR Database WMS Software eMEdNY System Medical Disability Determination System HEART system Microsoft Office Suite (Word, Excel, PowerPoint) Maximus Software PROFESSIONAL EXPERIENCE
Health Insurance Specialist/Medicaid Eligibility
(NYS DEPARTMENT OF HEALTH (STATE DISABILITY REVIEW UNIT)) Albany, NY 2015– Present Review and maintain healthcare provider records to ensure compliance with state, local, and federal standards. Manage a team of professionals and assign projects to case workers. Execute workflow, track client records and deadlines to ensure managing cases effectively.
Review and process patients' data to ensure adherence to the state guidelines and to determine their eligibility for Medicaid. Gather financial data from the resident, family and responsible party. Review and maintain healthcare provider records to ensure compliance with state, local, and federal standards. Communicate with the patients' authorized representatives to gather data and information necessary in executing Medicaid disability cases.
Escalate complicated cases to management in a timely manner. Receive and review all applications from 50+ counties, to determine eligilibity of patients for Medicaid. Manage and ensure existence and compliance of third-party insurance companies for Medicaid patients. Verify the accuracy of the data uploaded in databases to maintain data quality assurance. File appeals with the appropriate agency when necessary. Respond to inquiries regarding Medicaid and other health insurance matter to a variety of internal and external stakeholders. Collaborate with the IT team to recommend the upgrade of a new system for the State Disability Review Unit that can be used to manage cases of all NYS counties and participate in the testing of the new system. This system allows for greater efficiency, and productivity in work.
Train a team to utilize various computer software testing to perform work remotely during the COVID-19 pandemic. Arrange a team to work on-site to do the tasks for all State Disability Review Unit at least once a week during the pandemic. Teacher Assistant, CAPITAL DISTRICT (BOCES) Albany, NY 2014 – 2015 Supported lead teachers through various tasks such as student supervision, lesson plan development, and lesson materials preparation.
Guided students with their learning development and devoted to building a nurturing and safe learning environment for them.
Worked closely with the lead teachers in developing and implementing educational plans to unleash the potential of the students. Assisted in developing lesson plans and lesson materials, and arrange educational activities under the instruction of the regular teachers.
Substitute Teacher, CAPITAL REGION (BOCES) Albany, NY 2009-2014 Performed the instructional and classroom management absence of a regular teacher to ensure comprehensive content coverage.
Adhered to the regular teacher's curriculum and lesson plans to ensure the consistency and optimal learning of the students. Worked efficiently with the existing learning structures and accountable for students' learning outcomes, growth, and advancement. Demonstrated ability to educate students with the highest degree of learnings while following the school standard curriculum guidelines.
Acquired various creative teaching methods to encourage the students to participate academically and facilitate learning competently. ADDITIONAL EXPERIENCE
Head Teacher, AMMAN PRIVATE SCHOOLS DISTRICT 2006-2008 Oversaw the day to day school activities and provided excellent leadership to achieve the mission of learning at the highest level. Provided high standard teaching techniques in the various curriculum such as Geometry, Algebra, Arithmetic, Physics, and Chemistry. EDUCATION
Bachelor of Science in Electrical Engineering University of Technology 1986 TRAININGS & CERTIFICATION
Financial Accounting Course Hudson Valley Community College Albany, NY 2018 Standard Query Language (PL/SQL) Training Hudson Valley Community College Albany, NY 2017 MS Excel Proficiency Certificate NYS & CSEA 2016