PROFESSIONAL SUMMARY

• Serve as Subject Matter Expert on Medicaid policy and program requirements for all phases of design, build and implementation of Maryland's Health Benefits Exchange integrated eligibility and enrollment system.
• 16 years of experience in ACA programs such as Medicaid, CHIP, SNAP and TANF eligibility.
• Knowledgeable of Medicaid eligibility standards and application procedures to include new eligibility standards using Moderate Adjusted Gross Income MAGI methodologies.
• Able to execute business process mapping and revision of policies needed to support Medicaid eligibility system requirements using CURAM .
• Serve as a conduit to upper management.
• Able to handle assignments, deadlines and work independently as well as in a team environment.
• Ability to perform independent research, review and analyze policy, regulation and draft policy procedures.

TECHNICAL SUMMARY

ACA, Medicare, Medicaid, MMIS, MS Office, Maryland Health Benefits Exchange, UAT, Change Management

EXPERIENCE

Confidential

Supervisor Rapid Response Team FTE

• Serve as Subject Matter Expert for Office of Health Care Initiatives and Support Services to identify issues in ACA operations to develop changes to policy and system integration.
• Assisted with the Development, Testing, and Implementation of current Health Benefits Exchange to include conducting fit gap analysis, facilitating, and leading design groups in gathering system and business requirements, documenting business requirements, designing system processes which includes screen shots, rules, system interface and batch designs
• Develop case scenarios used for User Acceptance Testing.
• Responsible for assisting in the development, planning and execution of change management activities for Maryland Health Benefits Exchange Project utilizing Curam Case Management and Organizational Change Management and Business Transformation Plans functionality and associated business processes.
• Responsible using business process analysis to create cases and business process flows.
• Currently and formerly participates in Internal and External Portal Deep Dive sessions on gap analysis to identify key areas critical for Plan Management with former state vendors Noridian and currently the Deloitte team
• Review and provided comments to upper management on functional and technical designs for CURAM extensions and configurations such as workflow and/or rules
• Provide comprehensive technical analysis on Medicare, Medicaid or ACA policy and procedures to local staff via Action Transmittals and webinar training.
• Responsible for implementing standard operating procedures with the development of the Rapid Response Team who provide technical support to local staff regarding system implementation, activations, system errors and functionality issues within CURAM.
• Responsible for the development of an on base application used as a contingency plan to house MAGI applications due to system inoperability

Environment: ACA, Medicare, Medicaid, UAT, Change Management, Gap Analysis, Requirements Gathering, MS Office

Confidential

Supervisor Office of Health Care Initiatives

• Interpret, develop, write and deliver training material to implement new legislation, particularly those related to the ACA using webinar and power point presentations.
• Responsible for introducing and developing training guides for case managers for System Processing and System Structure of Medicaid Management Information System II MMIS-II . Responsible for training case managers, addressing policy issues and questions relating to the determination of technical and financial eligibility for Medicaid, MCHP, SNAP and TNAF.
• Review proposed Federal and State legislation for changes in legislation, policies or procedures based on either operational experience or changes in the function of the Agency.
• Supervising and provide guidance to 6 Family Investment Specialist and provide mentoring to 8 policy analyst dedicated to providing system support and training to implementing procedures, practices and policies related to the Affordable Care Act ACA .
• Respond to inquiries from local departments, the public, local, State or Federal offices as well as, the Governor's or Mayor's office, advocacy groups, legislators or other state agencies regarding aspects of federal and state programs.
• Serve as project manager on systems work groups, and as a security monitor for Family Investment Administration.
• Complete forms for submission to OTHS on behalf of FIA staff for access to active directory, Google accounts, legacy systems and password resets.

Environment: ACA, Medicaid, MS Office

Confidential

Human Service Specialist/Lead Policy Analyst

• Assisted in the preparation of testimony for executive level staff updated policy manuals reviewed, interpreted and evaluated Federal and State laws, regulations, policy and procedures wrote action transmittals, information memos and other training materials created forms, charts, and other materials for statewide use to administer FIA programs advised staff from other administrations and local departments on FIA programs, policies and procedures. Made recommendations to change policy and procedures served as a policy expert/liaison for FIA programs and coordinated and delivered training for community based organizations and other state agencies.
• Researched and reviewed Maryland COMAR
• Performed local department training needs assessments and performed other related duties as required
• Partnership member with Federal USDA , State DHR , and Baltimore City on outreach initiatives and activities to increase program participation to Food Supplement Program customers, clarifies governmental regulations and modifies the Code of Federal Regulations
• Translates and/or modified Federal Regulations to simplified language for training purposes
• Explain program differences based on Titles II, IV, XVI, XX, etc. and other laws that affect program rules
• Provide instructional records management on form completion methods and practices including Vocational Social Data, Medical reports, etc.
• Write and update federal regulations and policy manuals Acts as liaison on Website Projects prepared logic to calculate program eligibility, monitors and develops material for the DHR Intranet
• Prepare written correspondence for executive level staff Instruct the reconsideration process to determine continued eligibility for the upcoming certification period
• Works with constituent services staff to do community outreach and resolve customer complaints
• Reviews, interprets, and evaluates Federal and State laws, regulations and policy and procedures. Write action transmittals, information memos, and other training materials.
• Create forms, charts, and other materials for statewide use to administer FIA programs
• Advise staff from other administrations and local departments on FIA programs, policies and procedures
• Train local department staff, non-profit organizations
• Make recommendations to change policy and procedures served as a policy expert/liaison for FIA programs and coordinated and delivered training for community based organizations and other state agencies performed local department training needs assessments and performed other related duties as required.

Environment: Executive communication, MS Office

Confidential

Family Investment Generalist

• Supervised and provided guidance to 7 employees in the Family Investment Administration who determined eligibility for state and federal programs
• Assisted with Performance Evaluation Plans, Assigned and reviewed completed cases, attended monthly staff meetings, provided training on new standard operating procedures, Reviewed and interpreted state and federal policy, procedures, laws and regulations. Compiled reports, updated parameters, wrote correspondence to employees. Provided counsel and made recommendations to immediate supervisor.
• Responsible for introducing and developing training guides for case managers for System Processing and System Structure of Medicaid Management Information System II MMIS-II . Served as training liaison responsible to train case managers on site and address policy issues and questions relating to the determination of technical and financial eligibility for Medicaid, MCHP and Waiver programs.
• Review and make recommendations for edit- the work of case managers for accuracy in policy, completeness and application of regulations. Assist case managers with CARES and MMIS input problems
• Communicated with supportive services in the agency HELP desk, Service staff, State Review Team, Clearinghouse staff in other jurisdictions or center offices
• Provide on-the job training of new staff, Interpret policy transmittals
• Provide coverage for absent case managers. Attend meetings in absence of supervisor.
• Complete and review changes needed for Medicaid Management Information System MMIS . Respond to inquiries from local departments, the public, local, State or Federal offices as well as, Governor or Mayor's office, advocacy groups, or other agencies regarding aspects of Medicaid eligibility
• Negotiated with Appeals' Representatives for the State of Maryland
• Prepared and presented arguments on Behalf of clients before Administrative Law Judges
• Traveled throughout the State of Maryland to seek resolution or appear for Administrative Hearings

Environment: Medicaid, MMIS, MCHP, MS Office