Regional Medicaid Liaison/Account Manager at Abri Healthcare (2022-09 – Present)
Specialize in Medicaid/Medicaid pending approvals and applications for all long-term care patients. Work with Business Office Managers to ensure compliance on policy and procedure; Communicate with VP of Revenue Cycle to ensure status of facilities and projects remain consistently updated. Oversee facility processes and procedures, ensuring documentation remains up-to-date and is reviewed at least annually for efficiency. Coordinate and assist with facility BOM with timely and accurate billing of Private Pay, Medicaid, and Hospice claims; Routine oversight and auditing of critical processes such as cash deposits and posting, Medicaid pending and application processes, census entry, ancillary posting and triple check. Communicate to BOM's & Administrators areas of concern or areas of improvement and writing and delivering coaching discussions and performance improvement plans as necessary. Complete review of documentation and perform end of month close processes while reporting on all revenue adjustments within the month. Initiate account adjustments as identified, and ensure compliance on resident demographics and payer set up by auditing hard financial files and AR system.
Ensure Resident Trust
Fund compliance and work to complete zero deficiency audits.
Experience in long-term care, with ability to demonstrate strong leadership, communication, and management skills.
- Experience in Point Click Care, Availity, RFMS, Simple LTC, Microsoft Office, TMHP
Traveling Business Office Manager at Abri Healthcare (formally Senior Care Centers) (2020-04 – 2022-08)
Ability to travel throughout the State of Texas area to facilities. Reconciliation of Resident Trust Fund accounts. Tracking all resident applications who apply for Medicaid assistance. Maintenance of accounts as needed. Train new Business Offices Managers on policies and procedures. Travel to Nursing Facilities to help Business Office Managers with Aging, Trust Fund, and other issues that they may be having and to ensure that collections are getting done in a timely manner.
- Work with Business Office Managers to ensure compliance on policy and procedure
- Communicate with VP of Revenue Cycle to ensure status of facilities and projects remain consistently updated
- Oversee facility processes and procedures, ensuring documentation remains up-to-date and is reviewed at least annually for efficiency
- Coordinate and assist with facility BOM with timely and accurate billing of Private Pay, VA, Medicaid and Hospice claims
- Routine oversight and auditing of critical processes such as cash deposits and posting, Medicaid pending and application processes, census entry, ancillary posting and triple check
- Communicate to BOM's & Administrators areas of concern or areas of improvement and writing and delivering coaching discussions and performance improvement plans as necessary
- Complete review of documentation and perform end of month close processes while reporting on all revenue adjustments within the month
- Initiate account adjustments as identified, and ensure compliance on resident demographics and payer set up by auditing hard financial files and AR system
- Ensure Resident Trust Fund compliance and work to complete zero deficiency audits
- Experience in Point Click Care, Availity, RFMS, Simple LTC, Microsoft Office, TMHP
Business Office Manager at Williamsburg Village (2019-01 – 2020-03)
Establishes and maintains accounts and account records for all receivables and payable for the facility. Prepares and submits statements on resident trust accounts and controls resident trust account. Prepares and reconciles Trust Fund bank account(s) and prepares bank deposits. Receives and receipts payments on accounts receivable. Controls and administers petty cash fund. Prepares and submits timely statements of account to residents or responsible parties. Monitors accounts receivable and advises Administrator of delinquent receivables or other account irregularities. Prepares and submits timely reports of financial transactions and financial condition of community.
Review Medicaid
Programs with families and determine if patient will be Medicaid eligible. Other duties as assigned.
Business Office Manager at Senior Care Centers (2018-07 – 2019-01)
Establishes and maintains accounts and account records for all receivables and payable for the facility. Prepares and submits statements on resident trust accounts and controls resident trust account. Prepares and reconciles Trust Fund bank account(s) and prepares bank deposits. Receives and receipts payments on accounts receivable. Controls and administers petty cash fund. Prepares and submits timely statements of account to residents or responsible parties. Monitors accounts receivable and advises Administrator of delinquent receivables or other account irregularities. Prepares and submits timely reports of financial transactions and financial condition of community.
Review Medicaid
Programs with families and determine if patient will be Medicaid eligible. Other duties as assigned.
IME/Accounts Receivable/Accounts Payable Coordinator at Mobile Dental Care (2017-08 – 2018-07)
Works at Mobile Dental Office that goes out to nursing facilities that deal in geriatric dentistry. Train Business Office Managers and corporate offices on how Medicaid work as well as policies and procedures. AR Coordinator for over 100 facilities. Work with facilities regarding Medicaid procedures and IME (Incurred Medical Expenses) process.
- Posts customer payments by recording cash, checks, and credit card transactions
- Posts revenues by verifying and entering transactions form lock box and local deposits
- Maintains records by microfilming invoices, debits, and credits
- Work on Onsite Systems
Medicaid Eligibility Specialist I, II, III/Supervisor at Texas Health and Human Services (2009-11 – 2017-05)
Obtains, verifies, and calculates all sources of income and resources to determine client financial eligibility. Interviews clients or authorized representative to gather information to determine eligibility for benefits. Conducts reviews to determine or verify eligibility or eligibility.
Documents case records using automated equipment to form a record for each client. Explains program services and policies and makes referrals to agency programs, other state agencies, and community resources. Develops payment plans to facilities to ensure accuracy of payments.
Monitors nursing facility records to verify discharges, admissions or related records to ensure facility compliance with state and federal standards.
- Communicates with others (internally or externally) to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or complaints
- Mentors new case workers
- Monitors case workers
- Back-ups supervisor when needed
- Works in TIERS and handles special assignments as well as complaints
- Monitors nursing facility compliance with state and federal requirements
- Supervised unit of 16, set up training for new employees, interviewed new candidates, approved time and leave in Oracle
- Attended trainings and scheduled staff meetings, evaluated workers and completed yearly evaluations
Human Services Tech IV at Texas Department of Family and Protective Services (2006-12 – 2009-10)
- Routes P1's and P2's Utilize Access HR and Right fax
- Maintain calendar and email on Microsoft Outlook, completes travel
- Completes 2054's maintain personal information, navigate cases, request criminal background checks, conducts abuse/neglect history checks enters physical, dental and school information, completes eligibility packets, update legal actions and logs conduct case searches
- Conducts Random Moment Time Studies
- Provides transportation for clients to and from appointments as requested by caseworkers and/or Unit Supervisor
- Observes and/or supervises parent and child visits
- Completes appropriate forms and documentation concerning client contact including data entry into IMPACT and other agency systems
- Maintain out-going paper and/or electronic appointment calendar for scheduling requests made by caseworkers/supervisor
- Performs other duties as assigned and required to maintain unit operations including performing various clerical duties such as typing, filing, faxing, copying, answering/receiving telephone inquiries, etc.
- Promotes and demonstrates appropriate respect for cultural diversity among coworkers and all work related contacts
- Attends work regularly in accordance with agency leave policy
Administrative Technician II at Texas Department of Insurance-Division of Workers' Compensation (2001-03 – 2006-11)
- Types, takes and transcribes information or handwritten notices for preparation of legal documents
- Work with timesheets and leave request submitted
- Back up team leader (coordinate schedules and leave)
- Stamp, date, record, sort and routes
- Fax and copy equipment, compile statistics and completes reports
- Answers telephone and provide all information including proceedings
- Backup switchboard operator
- Order supplies
- Maintain inventory
- Receives records, transcribes, types, and edits subpoenas, decisions, orders, and other correspondence as directed
- Communicate with managers, private sector business, insurance carrier, law firms, and representatives and other internal as well as external customers all mail
- Develops, coordinates, and maintain record keeping system for files and records
- Cross-train all additional and new staff in the proceeding support area
- Exports Decision and Orders to Austin for Hearing Officers, answers questions that includes inquiries, up coming hearings, continuances, cancellations, and request for orders
- Handles Benefit Review
- Pre-Hearing and Contested Case Hearing information
- Reviews Benefit Review
- Pre-Hearing and Contested Case Hearing within the required time frames
- Pulls BRC diary daily and BRC docket weekly
- Schedules and order interpreters for upcoming Benefit Review Conferences and Contested Case Hearings
- Exports Decision and Orders to Austin for Hearing Officers, answers questions that includes inquiries (i.e. up coming hearings, continuances, cancellations, and request for orders)
- Retires all Contested Case Hearing files to Austin and purges all other files that pertain to proceedings
- Inquire; review, sort and schedule all Form-32's that come into the office for Designated Doctors
- Assist Dispute Resolution Officers in typing letters of clarification, EES-80, and no show letters and all other correspondence to claimants all other parties
- Assist Official Action Officers with all correspondence
- Coordinates docket settings for Benefit Review/Pre-Hearing and Contested Case Hearing Officers
- Uses mainframe system to enter, retrieve, and review worker's compensation claim information to claimant's, attorneys, insurance carriers, and adjuster
- Review appeals decisions, operates personal computer and mainframe terminology
Clerk III at Texas Health and Human Services (1996-08 – 2001-02)
- Maintain a regular and predictable work schedule
- Screened and reviewed all applications for Food Stamps, TANF, and Medicaid
- Scheduled appointments for a case load of over 5000 clients
- Answered phone calls regarding clients and benefits
- Receptionist (Greet clients)
- Issue Lone Star Cards / train clients on how to use properly
- Order supplies
- File/Pull cases
- Sort, date, distribute mail and all other correspondence
- Log and distribute faxes
- Interact with public, other state agencies and fellow employees
- Take changes reported i.e. clients start work, household changes, client stop working
- Issue temporary Medicaid cards for doctors' visits
- Back up Secretary III when out by ensuring time sheets are done, accounting for any leave taken and typing staff meeting notes and other duties supervisor may assign
