Team Lead Community Outreach

ROWENA KRON

PROFESSIONAL EXPERIENCE

STATE OF MARYLAND, Odenton, MD Jan 2024 - Present

Healthcare Benefit Exchange/LTSS Analyst (Contract)

Team Lead for Special Projects Unit involved in resolving escalated medically needy cases for the State of Maryland Healthcare Connection.

Conducted quality audits on eligibility determinations in compliance with Code of Maryland Regulations (COMAR) Case Management - risk assessment and safety planning.

Assisted developmentally disabled applicants undergoing eligibility determination for federal and state programs

(Waiver/HCBS).

Analysis of cases for technical qualifications for federal/state programs and access to resource/income-based access to medical care.

Participated in community outreach events to maintain community relations. MARYLAND DEPARTMENT OF HEALTH, Baltimore, MD May 2022 - Jan 2023 Compliance/Ethics/Quality Analyst (Contract)

Trained and executed application of government regulatory requirements in reducing waste and preventing fraud in medical billing/coding under Maryland Code of Regulations requirements.

Performed duties of Maryland Department of Health provider services in analyzing and approving medically necessary covered services for participants qualified under Intellectually and Developmentally Disabled Home and Community Based Services coverage.

Review program compliance and professional licensing requirements as per government's standard ethics of care under the Medicaid and Codes of Maryland Regulation (COMAR) Guidelines as mandated by the state and federal governments.

Recorded and Tracked case status in SharePoint.

IPS LYNX, Baltimore, MD Aug 2020 - Dec 2021

Program Manager of Compliance/Ethics (Contract)

Director of Operations overseeing contract between IPS Lynx, Inc and MD Transportation Authority.

Managed remote and on-site employees during COVID pandemic.

Reviewed licenses, qualifications and professional histories of healthcare professionals as required by the ethical standards of practice as stipulated by government contract (State of Maryland, Baltimore).

Supervised 22 talents performing functional assessments for mobility link transportation certification during COVID Pandemic.

Managed business operations during the COVID Pandemic while recertifications and eligibilities PARA- Transit benefits became a multi-function service goal in avoiding further spread of the virus.

Attended community outreach and communicated with the public, consumers and participants as well as professional caseworkers/providers to fine-tune coordination of services.

Supervised administrative review of existing Mobility Link processes in response to existing MTA (MD Transportation Administration) class action suit agreements of 2017.

Collaborated with MTA external departments in facilitating efficient transportation for functionally disabled riders during COVID Pandemic.

CAPITAL COMMUNITY SERVICES LLC, Washington, DC Mar 2015 - Jan 2019 Corporate Compliance, Quality and Ethics Officer

Operated a clinical office providing services in Mental Health and Behavior Rehabilitation services for homeless veterans.

Managed 79 staff members and other professional providers during day-to-day operations.

Participated in government and community outreach programs/trainings.

Investigated professional background and license of medical personnel as part of Corporate Integrity Agreement in the provision of healthcare — mandated by the agency's ethical standards of service.

Conducted review of monthly revenue streams and productivity reports against cost of general business operations and productivity.

Conducted investigations on healthcare compliance, HIPAA/privacy issues, and false claims incidents as reported by the community and other stakeholders.

Administered Corporate Integrity Agreement's requirements as per the mandates of the Washington D.C. Department of Behavioral Health, City Finance Department and Office of Inspector General regarding Clean Hans Billing process and consumer certification requirements under the Dixon Settlement.

Conducted monthly clinical audits and medical team training as part of continued excellent quality performance (Human Resource Oversight)

Develop Compliance Program, Internal Trainings, Audit and Review of Clinical Documentations for trending and reporting purposes.

Review and Investigate Reported Fraud and Abuse (Medicaid/Medicare Programs) Clinical

Documentation Audit and Review in conjunction with Washington D.C. Office of Accountability. STATE OF MARYLAND, Columbia, MD Jan 2009 - Mar 2015 Health choice Analyst

Oversaw operations of call center operations for the State of Maryland during the rollout of the Affordable Care Act of 2010 open enrolment roll-out.

Person to Person policy dissemination and MMIS corrections for crisis cases.

Maintained staffing coverage(s) for the office of the DHMH HealthChoice Division. STATE OF MARYLAND, St Mary*s County, MD

Compliance Officer & Administrative Hearings Representative

Reviewed 900+ Medicaid cases for fraudulent billing practices, overpayments, double-billing, or noncompliance.

Implemented corrective actions resulting from filed eligibility determination appeals.

Identified government errors in eligibility and processed overpayments on entitlement programs.

Advocated for affected recipients of the improper government application of Work Program Requirements.

Held District Program Investigator position and worked in conjunction with the Office of the Inspector General. EDUCATION AND TRAINING

SOUTHERN NEW HAMPSHIRE UNIVERSITY Hooksett, NH

Masters' Program Area of study in Public Health Management and Administration SAINT LEO UNIVERSITY St. Leo, FL

Bachelor of Arts - BA Criminal Justice/Law Enforcement Administration SAINT LEO UNIVERSITY St. Leo, FL

Masters' Program Area of study in Criminal Justice - Critical Incident Management and Public Policy STATE OF MARYLAND/FLORIDA PROGRAM TRAININGS

Medicaid/Medicare; Para-Transit/Mobility Transportation Certification; SNAP; Temporary Cash Assistance (TCA), Childcare Voucher, TDAP, Long Term Care (LTC).

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