Takishia Baynard

Medical Care Program Associate II - Team Lead - Department of Health and Mental Hygiene Baltimore, MD 21212

adpqi2@r.postjobfree.com

443-***-****

Authorized to work in the US for any employer

Work Experience

Medical Care Program Associate II - Team Lead

Department of Health and Mental Hygiene - Baltimore, MD March 2013 to Present

Baltimore, MD 21201

Medical Assistance Problem Resolution Division (MAPRD) Long Term Care Resolution Unit

Medical Care Program Associate II - Team Lead (3/2013-CURRENT)

• Receive, review, research, investigate and resolve customer eligibility determination and/or system issues/problems causing payment delay of Long Term Care and Hospital Medicaid claims.

• Independently apply knowledge of State and Federal policies and procedures for Long Term Care, community Institutional and Hospital stays to process DHMH 257 Long Term Care Activity Reports, DES 1000 forms and change of ownership (CHOW) patient listings in CARES and the MMIS II systems to facilitate provider billing and Medicaid payments.

• Using LDSS approved notice of eligibility and/or notices in change in available income make system corrections of customer resource and Social Security (OASDI) income changes to allow providers to file applicable adjustments to patient liability cost.

• Complete and forward weekly case status reports of resolved, pending and unresolved cases for management review. Identify, compile and forward Waiver, REM and Hospice special program conflict case request reports for MMIS II special functions manual system work around carve out modifications.

• Assist current and new LTCRU staff with training regarding day-to-day case management, provider claim reviews and payment denial resolution.

• Forward resolution correspondence and/or return request notifications for pertinent eligibility documents to complete case resolution and payment.

• Apply knowledge of State and Federal policies and procedures for Long Term Care, community Institutional and Hospital stays to identify, correct/update applicable customer eligibility and/or institutionalized patient stays in the Client Automated Resource Eligibility System (CARES). Interpret, determine, and translate program regulations with appropriate patient eligibility and provider payment data by completing and forwarding internal manual system correction document requests for Maryland Medicaid Information System (MMIS II) online batching errors, updates and/or provider payment spans.

• Collaborate and confer with inter-departmental contacts, LDSS, Hospitals, Nursing Home affiliates and financial billing agents to efficiently verify, track and correct customer post-eligibility billing issues to facilitate Medicaid payments to providers.

• Complete weekly case intake of logging, tracking, keying inquiry data of outstanding bill amounts, demographic information, healthcare provider identification data, outstanding billing dates etc., into the units' Microsoft MAPRU Access database.

• Compile and prepare provider non-payment inquiries for hardcopy case record assignment and dissemination to the units' LTCRU Staff Specialists for case review and resolution.

• Attend off site system requirements meetings/sessions to identify and discuss PRU 257 system conversion tasks and business rules for release and implementation in the MYDHR Website/Portal. Business Office Coordinator/Medicaid Specialist

ManorCare Roland Park - Baltimore, MD

August 2007 to August 2012

• Preparation and receipting of bank deposits, General and Trust, logging of cash, and lock box deposits.

• Completed the daily deposit call in procedures and log.

• Cash Posting

• Keying of therapy and other ancillary charges into PCC system

• Daily Reconciliation with census.

• Met daily with Nursing Home Department Heads to discuss activities, resident issues/concerns, and internal procedures

• Collaborated with Admissions to discuss insurance issues and concerns.

• Met with Nursing Home residents and their families to settle health insurance issues.

• Served as a liaison between resident family members, and the Department of Social Services when applying for Maryland Medicaid.

• Assisted families in the Medicaid process, by helping them to complete the Medical Assistance and/ or Social Security Disability applications and collecting documents required by the Department of Social Service, and also attending the MA appointment when family representatives were unavailable.

• Following up with the Department of Social Services eligibility workers to get status of pending Medicaid cases.

• Participated in weekly Medicaid pending calls with the Regional Director, Administrator, and Medicaid billers at the Centralized Business Office.

• Applied State and Federal policy and procedures when completing Medicaid recertification process for Medicaid residents.

• Compiled 3871B's and submitted to Nursing for completion.

• Requested level of care (LOC) certifications from Delmarva Foundation UCA required to complete DHMH 257 Full MA stays for LDSS and LTCRU processing to facilitate nursing home payments.

• Completed and submitted Representative Payee forms to Social Security.

• Responded to inquires from families and residents about billing.

• Collected payments for private portion amounts due from families.

• Collected monies owed on large balanced delinquent private accounts

• Monitored delinquent accounts and implemented collection procedures

• Mailed follow-up letters and accepted payments on all accounts and assisted patients with information on payment arrangements

Income Maintenance Specialist II/ Medical Care Program Associate II - Team Lead

Department of Human Resources - Baltimore, MD

August 1997 to 2007

Baltimore, MD 21201 (Unit transfer to DHMH in 8/2003) Department of Health and Mental Hygiene, Baltimore, MD 21201 Medical Assistance Problem Resolution Division

Long Term Care Resolution Unit

Income Maintenance Specialist II/ Medical Care Program Associate II - Team Lead (1997-8/2007)

• Received, researched, investigated and resolved customer eligibility determination problems causing payment delay of Hospital and Long Term Care Medicaid claims.

• Apply knowledge of State and Federal policies and procedures for Long Term Care, community Institutional and Hospital stays to process DHMH 257 Long Term Care Activity Reports, DES 1000 forms and change of ownership (CHOW) patient listings in CARES and the MMIS II systems to facilitate provider billing and Medicaid payments

• Using LDSS approved notice of eligibility, made system corrections of customer resource and Social Security (OASDI) changes to allow providers to allow providers to file adjustments to patient liability cost.

• Prepared and forwarded correction documents to the Department of Health and Mental Hygiene to correct and/or update customer eligibility or system error on the Client Automated Resource Eligibility System (CARES) and the Maryland Medicaid Information System (MMIS II).

• Collaborated and conferred with my Department, LDSS Hospital, Nursing Home affiliates and financial billing agents to efficiently verify, track and correct customer coverage to facilitate Medicaid payments to providers.

• Log and track case records of outstanding bill amounts, demographic data, healthcare provider data, etc., using Microsoft Access database.

• Complete weekly case intake of logging, tracking, data keying inquiry data of outstanding bill amounts, demographic information, healthcare provider identification data, outstanding billing dates etc., using the units' Microsoft MAPRU Access database.

• Processed DHMH 257 LTC Activity Reports and DHMH 259 Medical Care Transaction forms on CARES to facilitate payment to Long Term Care facilities. Daycare Attendant

BALLYS TOTAL FITNESS/WHITE MARSH - White Marsh, MD 2000 to 2001

• Greeting member and children as they entered the Daycare

• Attended to children in daycare center while parents worked out in the gym area.

• Maintained sign in/out logs

• Clean up after children and created activity activities to keep children occupied Office Clerk II

Department of Human Resources - Baltimore, MD

1996 to 1997

• Processed DHMH 257 and DHMH 259 Medical Care Transaction forms on CARES to facilitate payment to Long Term Care facilities.

• Provided ongoing reviews and modifications of provider information on the CARES vendor file.

• Responded to inquiries of outside vendors and stakeholders regarding eligibility determination and/or processing for specific categories of eligible customers.

• Served as liaison between the Local Department of Social Services, the Department of Health and Mental Hygiene and Nursing Homes.

• Maintained a filing system of reports, records, forms and other materials according to office procedures.

• Updated and maintained logs, schedules, Roosters of Nursing Home changes and case listings for supervisor and unit specialists.

Education

Early Childhood Education

Baltimore County Community College in - Baltimore, MD January 2016 to Present

Baltimore City Community College

2012 to 2014

High School Diploma

Baltimore City College - Baltimore, MD

1987 to 1991

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