Open To Work
Amelia Luna
Ralls,TX
Summary
Results-driven Medicaid Specialist with Texas Department of Health and Human Services, adept at eligibility determination and policy analysis. Enhanced application processing efficiency through innovative solutions, while delivering exceptional customer service. Proven ability to collaborate effectively and manage high caseloads, ensuring compliance and accuracy in a fast-paced environment.
Overview
49
49
years of professional experience
Work History
Eligibility Medicaid Specialist
Texas Department of Health and Human Services
Lubbock Texas
04.1976 - 04.2025
- Conducted eligibility determinations for Medicaid benefits, ensuring compliance with state regulations.
- Assisted clients in navigating application processes, enhancing user understanding of healthcare options.
- Reviewed and processed complex case files, maintaining accuracy and adherence to guidelines.
- Collaborated with interdisciplinary teams to resolve client inquiries and streamline service delivery.
- Developed training materials for new staff to improve onboarding efficiency and knowledge retention.
- Implemented process improvements that reduced processing time for applications, enhancing overall service quality.
- Led initiatives to enhance data management practices, improving reporting accuracy and operational efficiency.
- Collaborated with healthcare providers to ensure timely submission of required documentation for patient claims.
- Provided exceptional customer service to Medicaid applicants, addressing inquiries and troubleshooting issues as they arose.
- Developed strong relationships with community partners, facilitating referrals and collaboration for optimal client outcomes.
- Reduced errors in Medicaid eligibility determinations through thorough case analysis and accurate data entry.
- Maintained up-to-date knowledge of federal and state regulations, adapting processes accordingly for compliance purposes.
- Interpreted complex regulations and guidelines, ensuring accurate application of Medicaid policies for each case.
- Conducted regular audits of case files to ensure accuracy, completeness, and compliance with regulatory requirements.
- Contributed to departmental goals by consistently meeting or surpassing individual productivity targets and deadlines.
- Assisted with policy development and implementation, ensuring alignment with state and federal regulations for Medicaid programs.
- Streamlined communication between departments by establishing clear channels of contact, resulting in improved workflow efficiency.
- Assisted in the development of training materials for new staff members, contributing to overall team success and growth.
- Implemented fraud prevention measures by diligently verifying applicant information against various databases and resources.
- Conducted comprehensive client interviews to gather necessary information for accurate program eligibility determination.
- Resolved complex cases requiring special attention or escalated intervention, demonstrating problem-solving abilities under pressure.
- Managed high caseloads efficiently while maintaining strict attention to detail and prioritizing tasks based on urgency.
- Enhanced Medicaid application processing efficiency by streamlining workflows and implementing best practices.
- Participated in continuing education opportunities to stay abreast of industry trends and policy changes relevant to the Medicaid Specialist role.
- Evaluated the effectiveness of current processes, recommending improvements to enhance efficiency and quality of service delivery within the department.
- Assisted clients with completion of applications and paperwork.
- Interviewed applicants and explained scope of different available benefits.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Communicated with people from various cultures and backgrounds on application process.
- Used computer-aided guidance packages such as skills assessment tools, career planners, psychometric tests, and personal inventories to assist clients in determining strengths and weaknesses.
Ralls High School Secretary
Ralls ISD
Ralls, Texas
07.2005 - 02.2017
- Managed daily office operations, ensuring efficient communication among staff and students.
- Coordinated scheduling for school events, meetings, and parent conferences to enhance engagement.
- Maintained accurate student records and facilitated data entry into school information systems.
- Processed incoming phone calls and inquiries, providing timely assistance to parents and visitors.
- Assisted in maintaining inventory of office supplies, ensuring availability for staff needs.
- Supported the administration by preparing documents and reports for internal meetings and audits.
- Collaborated with teachers to streamline administrative processes, improving overall efficiency within the office.
- Trained new staff on office protocols and systems, fostering a supportive work environment.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Enhanced office efficiency by streamlining administrative processes and implementing new organizational systems.
- Prepared cash deposits from school activities and made bank deposits.
- Composed letters, memos, reports on behalf of administration when necessary, ensuring clear communication across various departments.
- Assisted in the development of school events and activities for increased student engagement and community involvement.
- Maintained an up-to-date inventory of office supplies by regularly monitoring stock levels and placing orders as needed.
- Contributed to a positive school atmosphere by greeting students each day with warmth and attentiveness upon their arrival at the main office area.
- Provided exceptional customer service to visitors at the front desk by offering assistance or directing inquiries to appropriate personnel as needed.
- Oversaw submission of accurate attendance records daily while following established procedures resulting in fewer discrepancies.
- Assisted in preparing district informational materials such as brochures and newsletters.
- Supported school administrators in daily tasks, contributing to a well-managed and organized work environment.
- Coordinated communication between parents, teachers, and administrators, fostering strong relationships within the school community.
- Placed orders for all classroom and office supplies.
- Assisted with budget preparation and tracking of expenditures for office related expenses, ensuring fiscal responsibility within the department.
- Efficiently resolved scheduling conflicts between faculty, staff, and students by implementing a streamlined process for booking meeting spaces and resources.
- Actively participated in professional development workshops related to High School Secretary role which enhanced skills set continuously.
- Processed incoming mail, distributing correspondence to appropriate recipients efficiently and accurately.
- Facilitated registration processes for new students by collecting required documentation and inputting data into the system accurately.
- Handled high volumes of phone calls and emails from parents, students, and staff members, providing timely responses while demonstrating professionalism at all times.
- Collaborated with other school secretaries to share best practices for improved overall performance among support staff teams.
- Contributed to a safe learning environment by promptly reporting any observed safety concerns or incidents to administration.
- Reconciled account balances and financial documentation such as bank statements, cash receipts and school accounts.
- Organized meetings, appointments, and conferences for staff members, maintaining a smooth-flowing schedule for all parties involved.
- Managed student records with accuracy and confidentiality, ensuring compliance with privacy policies and regulations.
- Offered guidance on various topics such as academic deadlines or attendance policies through thorough knowledge of school resources available.
- Processed student registrations and withdrawals.
- Answered multi-line telephones and greeted visitors and parents to facilitate office operations.
- Performed clerical and administrative support duties to optimize workflow procedures.
- Documented attendance, grades and test scores to update permanent records.
- Exercised judgment within school policy guidelines to alleviate principal's workload.
- Participated in meetings, workshops and seminars to covey or gather information to perform functions.
- Managed filing system, entered data and completed other clerical tasks.
- Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
- Assisted coworkers and staff members with special tasks on daily basis.
- Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
- Completed forms, reports, logs, and records to quickly handle all documentation for human resources.
- Built and maintained excellent customer relationships through timely response to inquiries and going above and beyond to accommodate unusual requests.
- Created and maintained detailed administrative processes and procedures to drive efficiency and accuracy.
- Continually sought methods for improving daily operations, communications with clients, recordkeeping, and data entry for increased efficiency.
- Interacted with vendors, contractors and professional services personnel to receive orders, direct activities, and communicate instructions.
- Volunteered to help with special projects of varying degrees of complexity.
- Identified and recommended changes to existing processes to improve accuracy, efficiency, and quality service.
- Established administrative work procedures to track staff's daily tasks.
- Liaised between clients and vendors and maintained effective lines of communication.
- Opened and properly distributed incoming mail to promote quicker response to client inquiries.
- Facilitated timely delivery of special projects to meet organizational and departmental objectives.
- Performed research to collect and record industry data.
Education
No Degree - Social Worker
Snyder Jr. College
Snyder, TexasHigh School Diploma -
Ralls High School
Ralls, Texas 05-1971
Skills
Appeals handling
Claims processing
Eligibility determination
Policy analysis
Medicaid expertise
Healthcare
Application processing
Policy interpretation
Medicaid
Interviewing techniques
Teamwork
Customer service
Problem-solving
Time management
Attention to detail
Effective communication skills
Problem-solving abilities
Multitasking
Languages
English
Native or Bilingual
Timeline
Ralls High School Secretary
Ralls ISD
07.2005 - 02.2017
Eligibility Medicaid Specialist
Texas Department of Health and Human Services
04.1976 - 04.2025
No Degree - Social Worker
Snyder Jr. College
High School Diploma -
Ralls High School