Jennifer Bedynek
Kingsville ,TX
Summary
Experienced Medicaid eligibility professional with 10+ years in eligibility systems, case auditing, and policy interpretation. Known for accurate case reviews, complex eligibility determinations, and strong knowledge of fair hearing processes.
Overview
14
14
years of professional experience
Work History
MEPD/TW Quality Assurance Field Services
Texas Health and Human Services
Kingsville, Texas
03.2023 - Current
- Performed routine social services audits to verify accuracy of program policies and procedures for MSP/MEPD and SNAP programs.
- Executed daily tasks with attention to detail and efficiency, ensuring smooth operations in a fast-paced environment.
- Collaborated with a diverse team to achieve project goals and address product-related challenges.
- Partnered with cross-functional teams to reach goals.
- Proposed innovative suggestions during team meetings, positively impacting team strategies and performance.
- Prioritized and organized tasks to meet service goals efficiently.
- Maintained up-to-date knowledge by participating in ongoing education and specialized training programs.
- Delivered friendly, knowledgeable service, enhancing customer satisfaction and fostering positive relationships.
- Assisted team members to foster a positive and cooperative workplace atmosphere.
MEPD Worker III lead
Texas Health and Human Services
Alice, Texas
03.2022 - 03.2023
- - Interview applicants or representatives, review financial, medical, and program criteria, and determine or review MEPD and long-term care waiver eligibility for programs such as STAR+PLUS HCBS and MDCP.
- - Use state and agency systems such as TIERS, SASO, and TMHP Long Term Care Online Portal to process, validate, and register cases.
- - Conduct phone or face-to-face interviews to assess initial and ongoing SNAP eligibility.
- - Interpret and apply federal, state, and local assistance rules to household financial and personal situations.
- - Coordinated with MEPD staff, managed care organizations, nursing facilities, and community partners to facilitate smooth transitions from nursing facilities to community living.
- - Assisted denied or disputed applicants with state fair hearing filings, tracking case progress to ensure timely final decisions.
- - Handled escalated cases, researched enrollment errors, guided lower-level eligibility staff, and monitored workflow reports to maintain operational efficiency.
Medicaid Eligibility Specialist 2
Texas Health and Human Services
Alice, Texas
03.2014 - 03.2022
- Processed Medicaid and SNAP applications in HHSC eligibility systems and kept case files current.
- Evaluated client documents against Texas Health and Human Services Medicaid eligibility standards to ensure compliance.
- Interviewed applicants to verify household income and residency details.
- Applied Texas Works rules and program policy guidance to determine eligibility.
- Requested missing verifications from clients and community partner agencies.
- Explained application status, required documents, and next steps to applicants.
- Entered case notes and kept records accurate in eligibility databases.
- Partnered with HHSC staff to fix complex case discrepancies and updates.
- Gathered and documented applicant income, assets, insurance coverage, and related data.
- Completed periodic audits of case files to support accuracy and completeness.
- Provided technical guidance to staff on program requirements and enrollment procedures.
- Supported outreach activities to increase awareness of available Medicaid services among eligible populations.
- Built working relationships with community organizations that support low-income families with health care access.
- Analyzed data trends to identify patterns in program performance. related to program performance metrics.
- Responded to inquiries from applicants and stakeholders regarding services. from applicants, providers, and other stakeholders about Medicaid services.
- Processed requests for changes in existing Medicaid cases.
- Completed initial eligibility screenings for Medicaid applicants.
- Updated case management systems with current client status information.
- Kept current knowledge of state and federal Medicaid eligibility regulations.
- Attended training sessions, seminars, and workshops related to Medicaid programs.
- Reviewed applications and supporting documents to determine Medicaid benefit eligibility.
- Prepared reports that summarized findings from eligibility reviews.
- Proposed enhancements to streamline processes and elevate customer service experience.
- Assisted individuals with completion of complex application paperwork.
- Worked with other departments to resolve Medicaid eligibility issues.
- Investigated complaints related to eligibility determinations or denials.
- Advised clients on best use of available resources to meet needs.
- Verified applicant financial information against third-party sources, including employers, banks, and government agencies.
- Researched discrepancies between submitted forms and available records to support regulatory compliance.
- Communicated daily with people from different cultures while showing respect and patience.
- Conducted interviews with applicants and explained benefits process and available programs.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Maintained confidential patient documentation to protect data and support HIPAA compliance.
- Reviewed applicant data carefully to assess compliance with economic assistance eligibility criteria.
- Informed applicants of other agencies that provided related assistance.
MEPD worker 1
State Of Texas - Health And Human Services Commission
Kingsville, Texas
03.2013 - 03.2014
- Reviewed Medicaid applications for eligibility under state program guidelines.
- Reviewed client income and residency documents for accuracy.
- Entered case details into eligibility systems and healthcare databases.
- Explained Medicaid coverage rules to applicants and community members.
- Managed renewals and redeterminations, ensuring timely processing of supporting documents for active cases.
- Worked with caseworkers, providers, and agencies on eligibility status.
- Applied policy rules to resolve missing information and case differences.
- Kept confidential records in line with Medicaid compliance and privacy standards.
- Provided technical guidance to staff on program requirements and enrollment procedures to enhance team understanding.
- Took part in outreach activities to increase awareness of Medicaid services among eligible populations.
- Built relationships with community organizations that help low-income families access health care services.
- Investigated complaints about eligibility decisions or denials.
- Advised clients on best use of available resources to meet needs.
- Processed requests for updates to existing Medicaid cases.
- Proposed process improvements that enhanced customer service and streamlined application handling.
- Reviewed applications and supporting documents to determine Medicaid eligibility.
- Attended training sessions, seminars, and workshops related to Medicaid programs.
- Worked with other departments to resolve Medicaid eligibility issues.
- Checked applicant financial information against third-party sources such as employers, banks, and government agencies.
- Helped individuals complete complex application paperwork.
- Maintained up-to-date knowledge of Medicaid eligibility regulations.
- Updated case management systems with current client information.
- Communicated with people from different cultures daily with respect and patience.
- Prepared reports that summarized eligibility review findings.
- Explained eligibility details and affordability options to patients with kindness and respect.
Education
Medical Assistant - Medical
Vocational School
Corpus Christi, TX05-2010
Skills
- Medicaid enrollment
- Eligibility databases
- Case reviews
- Policy application
- Case coordination
- Hearing assistance
Timeline
MEPD/TW Quality Assurance Field Services
Texas Health and Human Services
03.2023 - Current
MEPD Worker III lead
Texas Health and Human Services
03.2022 - 03.2023
Medicaid Eligibility Specialist 2
Texas Health and Human Services
03.2014 - 03.2022
MEPD worker 1
State Of Texas - Health And Human Services Commission
03.2013 - 03.2014
Medical Assistant - Medical
Vocational School