Eligibility Worker Enrollment Specialist

Sonja McGruder

**** * ************ *****

Chesterfield, VA 23224

Phone: 804-***-****

E-mail: *********@*****.***

Objective

I am driven, compassionate and an administrative professional with many years of hands-on experience in fast-paced office and medical facility environments with leadership and supervisory training. In addition, I have strong knowledge of Personnel Policies, Medicaid procedures, insurance coverage, HR guidelines and policies. Therefore, I am looking for a position that allows me to utilize the skills and education I have obtained to be a great asset to your company.

Experience

Maximus Inc.

05/2021-9/2022 Eligibility Supervisor

• Analyze family cases for Medicaid & Cover VA

• Responsible for the delivery of the KPIs of the teams, including quality, productivity, and compliance

• Manage and Supervise team of 25

• Deliver regular and timely coaching and feedback to team members to improve performance

• Explain program benefits, requirements, and procedures, including eligibility factors to clients

• Responsible for hiring & terminating decisions, performance appraisals, pay reviews and training

• Engage with other management/training to identify areas of opportunity to develop more training

• Planning and organizing large caseloads, ensuring that accuracy levels are maintained and processed within the specified timeframes set by federal and state regulations

• Determine program eligibility in accordance with current regulations

• Follow up with clients by phone with application status

• Provide information and make routine referrals to resources available through the city, county, and within the community for clients who desire further service

Accountantsone

12/2020-04/2021 HR Generalist

•Ran daily reports on timesheets, absences and any company leave

•Maintain schedules for all HR departments including training, hiring events and any company events

•Work with Guarantors or any outside vendors to secure payment for any company services

•Update employee records to identify any issue that may go against any laws or company policies

•Maintain Employee Payroll and maintaining timesheets for all assigned localities

•Ensure company is up to all FLSC regulations

•Work with all departments and leadership to make sure the company is adhering to all standards and practices

•Assist in hiring process by conducting in person and tele interviews

Virginia Department of Medical Assistance Services, Richmond, VA

09/2017-03/2019 Team Lead Eligibility Support Assistant/Paralegal

Paralegal:

• Part of five-person support team, providing administrative assistance to 10 client hearing officers

• Develop business relationships with internal contacts and Stakeholders

• Develop project plans and workflows through communication with all applicable parties

• Facilitate internal and external correspondence

• Serve as liaison between Hearing Officers and internal contacts

• Monitor and maintain client files

• Create and analyze regular reports

• Monitor contractual service levels for assigned cases to ensure compliance

Team Lead

Supervised a staff of 5 which allowed me to:

• Mentor my peers and associates

• Oversee the day-to-day operations of my team to support the division as a whole

• Participate in weekly and daily team meetings to coordinate work, assist peers with backlogged cases

Department of Medical Assistance Services, Richmond, VA

10/2016-09/2017 Enrollment Specialist

• Newborn Enrollment and Notifications

• Processing of E213’s through MMIS, Champs & ODM

• Processing of SVES Request for contractor Cover VA

• Application processing/Spenddowns

• Quality Assurance scoring for Cover VA

Department of Social Services, Richmond, VA

10/2015-03/2016 Program Specialist I (P14)

• Researching cases using the state system to determine correct case status in multiple systems to include ADAPT, MMIS, VaCMS, & SPIDER

• Collect and analyze past due renewals for the city of Richmond

• Sending and Receiving correspondence

• Inbound/Outbound calls from clients

• Re-determine /Reinstate/Open/Close all cases

Xerox State Healthcare, Richmond, VA

09/2007-04/2014 Eligibility Worker

• Analyze family cases for FAMIS, Medicaid & Cover VA

• Explain program benefits, requirements, and procedures, including eligibility factors to clients

• Research questionable information until satisfactory explanations regarding eligibility statuses are confirmed

• Establish and maintain multiple case files through regular updating and review

• Planning and organizing large caseloads, ensuring that accuracy levels are maintained and processed within the specified timeframes set by federal and state regulations

• Determine program eligibility in accordance with current regulations

• Follow up with clients by phone with application status

• Provide information and make routine referrals to resources available through the city, county, and within the community for clients who desire further services

Education

Thomas Jefferson High School, Richmond, VA

High School Diploma

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