Lauren Rainey
Senior Eligibility Specialist (Team Lead)
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About
Detail-oriented and results-driven Eligibility Specialist with leadership experience in Adult Medicaid programs. Proven ability to train and mentor staff, improve team performance through data-driven insights, and ensure compliance with state and federal regulations. Strong communicator with a track record of managing high-volume caseloads, streamlining processes, and supporting cross-functional teams. Adept at multitasking in fast-paced environments while maintaining accuracy and efficiency.
Experience
Senior Eligibility Specialist (Team Lead) - Union County Social Services - Monroe, NC
(2022-03)
- Lead training and onboarding for new and existing caseworkers across Adult Medicaid programs (PLA and LTC).
- Develop and deliver group and individualized training sessions based on performance data and team needs.
- Conduct second-party reviews of applications to ensure compliance and minimize internal control errors prior to state audits.
- Analyze trends from audits and reviews to improve processes and training effectiveness.
- Provide ongoing coaching and follow-up to ensure understanding of policies and procedures.
- Present cases and documentation during county and state REDA audits.
- Collaborate with leadership to enhance team performance and operational efficiency.
Eligibility Specialist - Vanguard Professional Staffing - Remote
(2022-07)
- Supported multiple counties (Mecklenburg, Durham, Pender) by processing Medicaid applications to reduce backlogs.
- Managed intake and redetermination cases across programs including PLA, LTC, CAP, and PACE.
- Maintained high productivity and accuracy in a remote, fast-paced environment.
- Adapted quickly to varying county processes and systems.
Eligibility Specialist - Union County Social Services - Monroe, NC
(2018-05 - 2022-02)
- Determined eligibility for Medicaid (Aged, Blind, and Disabled) based on income and resource criteria.
- Conducted client interviews in person and by phone to gather and verify information.
- Managed high-volume caseloads, including intake and pending applications.
- Completed DDS assessments in NCFAST and coordinated with SSA and DDS on disability determinations.
- Collaborated with hospitals and emergency services to process urgent Medicaid cases.
- Assisted clients with program navigation and referrals to additional resources.
- Contributed to training development based on quality review findings.
4th Grade Teacher - Anson County Schools - Wadesboro, NC
(2017-08 - 2018-05)
- Developed and implemented curriculum tailored to diverse learning needs.
- Collaborated with faculty, administrators, and parents to support student success.
- Monitored student progress and implemented strategies to improve academic and behavioral outcomes.
- Made referrals and coordinated with support staff as needed.
Education
Bachelor of Science - Human Services - Wingate University (2017-05) Wingate, NC
