Quality Assurance Control
Resume:
Valerie Henry
*** *** ****, *******, ** *****
**********@*****.***
Medicaid Eligibility Subject Matter Expert (SME) with over 30 years of experience in Health and Human Services policy. Vast knowledge of federal and state regulations, excellent written and oral communication skills, and extensive research skills. Medicaid expertise includes ten years as a Medicaid Eligibility Quality Control Investigator reviewing MAGI and Non-MAGI coverage groups. Served nine years as an administrative Hearing Officer for all categories of eligibility, including MAGI/Non-MAGI, Long Term Care, Disabled Child Living at Home, and CHIP, Breast and Cervical Cancer, and Home and Community Based which administered Provider, Eligibility, and Medical Service appeals, while simultaneously serving as a Hearing Officer for Medical Services and Eligibility appeals.
IV&V experience as a Consultant/Medicaid Policy SME for Medicaid Enterprise Systems (MES) projects in Mississippi, Florida, and Colorado, working on systems implementation projects using agile, waterfall, and hybrid agile methodologies. Tracked action items, risks, issues, findings, and recommendations. Reviewed deliverables and performed quality assurance in areas such as requirements gathering, requirements management and tracking, release management. Also provided consultation and quality assurance on various non-Medicaid related projects.
Self-driven, strong attention to detail, able to work independently with little supervision and in a team environment. Identifies problems and recommends possible solutions. Dedicated, curious, and determined, constantly seeking to improve and learn new skills.
Experience
Nov 2023 – Dec 2024
Information Technology Sr., Principal Consultant/NTT DATA
Analyzed business processes to identify and assess risks and issues, shared findings and recommended resolutions. Gathered information by attending meetings and documenting project decisions. Conducted quality reviews of deliverables and other project artifacts throughout the System Development Life Cycle. Supported preparation of weekly and monthly report and deliverables as required by the project contract. Conducted research on state and federal regulations, and monitored project progress and adherence to Agency standards. Collaborated with team members to meeting project requirements and deadlines for deliverables. Maintained log of project risks, issues, decisions, and action items.
Past projects include:
●11/2023 IV&V and Quality Assurance services, Florida Health Care Connection (FX), Agency for Health Care Administration (AHCA) Provider Service Module.
May 2019 – Jan 2023
Management Consultant/Public Knowledge, Jackson MS/Remote
Analyzed business processes to identify and assess risks and issues, shared findings and recommended resolutions. Conducted quality reviews of various documents generated throughout the system development life cycle.
Reviewed test plans, monitored user acceptance testing, and completed incident reports. Contributed to monthly and quarterly CMS reports and created weekly status reports. Gathered project information by conducting interviews and surveys, analyzing documents, researching best practices, and applying other information-gathering tools. Collaborated with team members by sharing knowledge, conducting research, meeting project requirements, and meeting deadlines for deliverables.
Past projects:
●7/2020 – 1/2023 IV&V services, Colorado Health Care Policy and Financing, Medicaid Enterprise Systems
●10/2021- 4/2022 Procurement Redesign, Louisiana Department of Children and Family Services, Department of Family Support
●11/2021-1/2022 Statewide needs assessment, Mississippi Department of Human Services, Division of Aging and Adult Services
●7/2021 – 12/2021 Quality Assurance, Washington Health Care Authority, Patient Access Application Programming Interface - Performed initial and ongoing risk assessment through stakeholder interviews, document reviews, and observing project meetings. Drafted, edited, and reviewed deliverables. Assisted in preparing an Initial Readiness Assessment and a Lessons Learned report.
●5/2019 – 6/2020 IV&V services, Mississippi Health and Human Services Transformation Project
Participated in planning meetings, daily standups, and Joint Application Development (JAD) sessions. Facilitated requirements development for the modular implementation by collaborating with the vendor in ensuring the use of applicable policy and terminology. Responsible for Medicaid Eligibility and Enrollment Toolkit reporting to the Centers of Medicare and Medicaid Services (CMS). Reviewed deliverables and contributed to the IV&V monthly report for CMS. Worked with the IV&V team to identify risks and issues. Reviewed test plans, monitored User Acceptance Testing (UAT) and completed incident reports.
Jul 2016– May 2019
Eligibility Staff Officer/Mississippi Division of Medicaid, Jackson, MS
Conducted troubleshooting and resolved MMIS System issues to facilitate the payment of claims by making corrections to dates and categories of eligibility and Medicare Buy-In errors. Created improper payment reports for recoupment of capitation payments made on behalf of ineligible recipients. Identified errors and inconsistent policy application among the eligibility regional offices and shared findings with the Bureau of Eligibility’s management team. Assisted Deputy Administrator in special projects as assigned.
MAY 2014- SEP 2016
Golf Shop Manager/Randy Watkins Golf, Madison, MS
Managed overall golf operations, enrolled new members, collected accounts receivable, and completed daily financial reports. Participated in tournament operations.
Mar 2010 – May 2014
Office Director II/Mississippi Division of Medicaid, Jackson, MS
As part of Medicaid’s Executive Office, centralized the agency’s appeal functions into a newly established Bureau of Appeals. Improved processing times to bring a two-year backlog of over 200 hearing requests up to date within 18 months. Responsible for the overall administration of the Bureau of Appeals while serving as a Certified Hearing Official for eligibility and medical service appeals. Collaborated with vendors, contractors, and other state agencies to identify policy and procedural issues and recommend corrective action. Reviewed, researched, and edited State Plan Amendments to the agency’s Administrative Code and provided clarification to the regional office supervisors and eligibility workers on policy issues.
MAY 1999 – Feb 2010
Medicaid Investigator/Mississippi Division of Medicaid, Jackson, MS
Completed Medicaid Eligibility Quality Control reviews and reported inaccuracies in policy application to the Bureau of Eligibility. Created and submitted improper payment reports to the Bureau of Program Integrity. Investigated reports of suspected recipient fraud and abuse. Also served as a Hearing Official for eligibility appeals from 2007 to 2010 in addition to Quality Control duties.
Jan 1996 – Apr 1999
Regional Office Assistant Supervisor/Mississippi Division of Medicaid, Jackson, MS
Oversaw daily operations of the Jackson Regional Medicaid Office. Reviewed casework for accuracy and made final eligibility determinations. Conducted training and policy workshops. Represented the Agency at community and sister-agency outreach meetings. Acted as Hearing Officer for eligibility appeals at the regional office level. Administered personnel matters. Developed various tools to monitor and maintain office efficiency.
Jul 1995 – Dec 1995
Medicaid Specialist/Mississippi Division of Medicaid, Jackson, MS
Determined eligibility and maintained a caseload including over 400 recipients. Assisted with training, community meetings, and local hearings.
mar 1994 – Jun 1995
Benefits Analyst/Mississippi Public Employees’ Retirement System, Jackson, MS
Prepared estimates and counseled future retirees about their benefit options. Processed benefits for payment for service retirement, disability retirement, and survivor benefits.
Jul 1989 – Feb 1994
Medicaid Specialist/Mississippi Division of Medicaid, Jackson, MS
Determined eligibility and maintained a caseload. Assisted with training, community meetings, and local hearings.
Certifications
●MLC Certified Medicaid Professional (MCMP-II)
●Certified Hearing Officer, National Association of Hearing Officers
●Level II Certified Public Manager, MS State Personnel Board
●Inaugural Class of Leadership Series, MS Division of Medicaid
Education
●Bachelor of Science, Business Administration, Belhaven University, Jackson, MS
Skills
●Stays abreast with changes in Federal and State regulations
●Extensive research skills
●Medicaid policy subject matter expert
●Medicaid Enterprise System DDI
●Business Analyst/Data Analyst
●Medicaid enrollment and medical service administrative appeals
●Excellent verbal and written communication skills
●Critical thinking and problem-solving skills
●Quality Assurance
●Fee for Service
●Managed Care/Capitation Payments
●Independent Verification and Validation (I&V)
●Software Development Life Cycle
●Agile/Waterfall methodologies
●Strong requirements elicitation and analysis skills
●Review Test Plans, create user stories and acceptance criteria
●SDLC
●CMS Reporting
Software & Tools
●Outlook
●MS Word
●Excel
●PowerPoint
●Office 365
●SharePoint
●Teams
●Zoom
●Jira
●Acumatica
●Ceridian/Dayforce
●SAP Concur
Interests
●Member of Mississippi State Athletic Alumnae Association (M-Club)
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