OBJECTIVE:

• To obtain a position with a reputable company that has room for advancement that will utilize my project management and business analysis skills such as system testing, managerial, training, Curam Software, MMIS software, ICD - 9 coding as well as awareness of the upcoming ICD-10 coding changes, and Health Insurance billing.
• Subject Matter Expert on Medicaid guidelines and procedures, specializing in member eligibility as well as provider services. Proficiency in using the EPIC software, NCFAST Curam software MMIS as well as NCTRACKS software.
• 10 plus years of Medicaid Operations experience.
• Professional experience in new product development and product management including product launch experience and knowledge of software development methodology, including principles of Waterfall, SDLC and Agile methodology.

PROFESSIONAL EXPERIENCE

Confidential

Medicaid Eligibility Supervisor

Responsibilities:

• Primary responsibility was to ensure the success of projects, including overseeing projects were completed on schedule, on budget, within scope, and meet the quality and standards of Confidential .
• Directed the daily activities of the staff.
• Coordinated account inventories and reported daily/weekly to the Department Manager.
• Prepared and conducted staff training while maintaining time and attendance records for staff.
• Problem solve operational issues, and conducted performance reviews.
• Coordinated overtime with the Department Manager to accommodate workloads.
• Met goals and objectives as assigned by management
• Reported and documented employee disciplinary problems to the Department Manager.
• Adhere to prescribed policies and procedures as outlined in the Employee Handbook.
• Assisting with other projects as assigned by management.
• Supervised a group of 30 employees.
• Provided product management leadership for connectivity tools; serve as the voice of the customer for new product development projects and execute product launch activities.

Confidential

Responsibilities:

• Provided system training on the NC FAST Curam case management system to NC FAST Staff and Local Social Services employees within the Confidential of North Carolina.
• Provided effective and creative classroom and virtual facilitation of training for all levels of employees who oversee and administered nine federal and state economic benefit/social services programs managed through NC FAST.
• Served as a Medicaid Subject Matter Expert for the NC FAST Helpdesk which included but not limited to: assisting Helpdesk Agents with troubleshooting and resolving Medicaid issues triaged through the NC FAST Helpdesk. Curam Software system was the main system used by the state of North Carolina.
• Participated in testing throughout the phases of the SDLC from requirements elaboration, design/development, test and deployment. Created and maintained all QA related documentation throughout the SDLC process.
• Provided hands-on guidance and lead project teams using Agile methods.
• Assisted in system testing and quality assurance process for related enhancements and new development. Ability to coordinate testing activities between several departments.

Confidential, NC.

Medicaid Technical Trainer (Supervisor) Subject Matter Expert

Responsibilities:

• Trained and mentored employees on the (MMIS) Medicaid Management Information System.
• Trained all agents on their technical, professional and communication skills.
• Responsible for the development and delivery of initial and ongoing technical and professional skills training for the entire provider services department for the NC Medicaid program.
• Experience with Business Analysis methodologies and problem solving.
• Revised existing training material and programs based on audit results, questionnaires, changing procedures and feedback from internal/external customers and subject matter experts.
• Supervised a group of 15 Medicaid travel representatives throughout the state of North
• Carolina. Training development created through the MMIS.
• Experience in tracking, planning projects, working with large data sets and making data-driven analytical decisions.
• Proficiency in MS Word (including creating tables; importing tables; incorporating mailing database information, et cetera. Previous experience presenting to internal and/or external teams. knowledgeable in both waterfall and agile project management practices and applied that knowledge to small project execution including status, SDLC, HOTS, Clarity, and financial support.

Confidential

Customer Service Manager/Medicaid Project Manager

Responsibilities:

• Supervised a group of 30 employees.
• Trained all new employees on all aspects of customer services techniques and the breakdown of all claims (i.e. UB -04, CMS-1500, ADA 2006 and POS Pharmacy Claims).
• Monitored performance metrics and goals of my assigned group.
• Performed audits of employees claim adjustments to ensure accuracy and knowledge of all plan benefits. Used the MMIS to train all employees on system configuration.Knowledge of project management principles, techniques, monitoring systems and software needed to manage multiple project s.
• Serve as the subject matter expert for collaborations with third party software i.e. Electronic Medical Record providers (EMRs, data integrators), and service partners as well as the expert for product offering, working with sales and key customers on a four year two hundred million project.

Confidential

Training Administrator/Claims Department

Responsibilities:

• Responsible for training all new and existing employees on how to accurately resolve problems concerning all health insurance claims.
• Trained groups of 20-30 employees for 6-8 weeks at a time.
• Other responsibilities included showing new hires on how to view and read a claim, medical records reading, and diagnosis and procedure code training. Trained all associates on BCBSNC products and services.