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Aetna Health Insurance - Medicaid Specialist Resume Example

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Claire Diaz
XXXXX XX XXX XXXXXX, PELHAM, NY 10803
Ph: XXXXX XXXXXXXX
XXXXXXXXXXXXXXXXXXXXX
Summary
To secure a position where my business analyst experience, leadership, and educational strengths can be applied to improve and expand business.
Skills
  • Critical Thinking
  • Time Management
  • Complex Problem Solving
  • Systems Analysis
  • Administration and Management
  • Operation Monitoring
  • Operations Analysis
  • Customer and Personal Service
  • Report Analysis
Experience
Medicaid Specialist/Business Analyst Oct 2013Present Aetna Health Insurance Miami, FL
  • Handling Medicaid paperwork and record keeping in a managed care setting.
  • Prepare and distribute Medicaid materials to providers, members, and clinical staff of the managed care team.
  • Document activities and record information in members file for ongoing case management.
  • Maintain case history records and prepare reports for managed care team to maintain members eligibility in Long Term Care program.
  • Train people in computer system use.
  • Expand or modify system to serve new purposes or improve work flow.
  • Train staff and users to work with computer systems and programs.
Health Care Assessment Manager Oct 2011Oct 2013 Living Systems Miami, FL
  • Managed a department of >25 clinical and non-clinical staff who's primary task was to perform telephonic health risk assessments for over 100,000 Medicare, Medicaid, and SPD members in over 8 states to collect social, clinical, environmental, and behavioral needs to create an individualized care plan to provide assistance to each member.
  • Implemented a training program to help staff use proper Medical terminology, phone etiquette, and handling of behavioral health members.
  • Re-organized the structure of the department and operations to ensure effectiveness and efficiency across the board.
  • Analyses of reports to ensure members are properly reached before Compliance deadlines to ensure Service Level Agreements are being met.
  • Conducted Analysis of data to ensure all CMS guidelines are being met prior to auditing by CMS on the Health plan.
  • Develop and interpret organizational goals, policies, and procedures.
  • Direct daily operations of department, analyzing workflow, establishing priorities, developing standards and setting deadlines.
  • Testing of functionality after quarterly systems upgrades and identifying functionality issues.
  • Assign or schedule tasks in order to meet work priorities and goals.
Case Management Team Lead Mar 2010Oct 2011 Living Systems Miami, FL
  • Coordinated care for SNP dual eligible members by developing, monitoring, and evaluating their social, environmental, and medical needs.
  • Reduced admissions for high-risk members with multiple co-morbidities and/or members who were a high risk for readmission to a hospital setting.
  • Assisted in the development of SPD work flow process to help track and focus on "high-risk" members.
  • Conducted testing of new updates to the care management system to correct any anomalies before sending to production view.
  • Created training manuals for remote and in-house staff.
  • Completed health risk assessments for dual SNP members with co-morbidities and mental health conditions to ensure all information was documented to develop an accurate individualized care plan.
  • Reviewed member care plans to ensure all documentation was meeting CMS guidelines.
Education
Bachelors : Psychology Jan 2013 Florida International University Miami, FL Psychology
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Resume Details

This is a real resume for a Medicaid Specialist in PELHAM, New York with experience working for such companies as Aetna Health Insurance, Living Systems. This is one of the hundreds of Medicaid Specialist resumes available on our site for free. Use these resumes as templates to get help creating the best Medicaid Specialist resume.

Previous Companies:

  • Aetna Health Insurance
  • Living Systems

Previous Job Positions:

  • Medicaid Specialist
  • Business Analyst
  • Health Care Assessment Manager
  • Case Management Team Lead

Schools:

  • Florida International University

Level of Education:

  • Bachelors

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