Jessica Jump
Frankfort,KY
Summary
Demonstrative Medicaid Specialist proudly offering 20 years of experience assisting others with enrollment and program services. Polished professional known for interactions that are fair, compassionate and respectful. Promoting issue resolution expertise in fast-paced environments.
Overview
20
20
years of professional experience
Work History
Medicaid Specialist III
Department for Medicaid Services-Pharmacy Policy
Frankfort, SD
04.2019 - Current
- Provides support, guidance and expert assistance to team members, recipients, providers, professional association of providers, vendors and government agencies in complex Medicaid pharmacy cases.
- Monitors PBM contracts for both Fee for Service and Managed care pharmacy vendors for quality assurance.
- Develops and recommends policies and procedures.
- Non-voting member for the Board of Pharmacy and Therapeutics committee.
- Hire, train and oversee work tasks for Medicaid Specialist II on staff.
- Assists directors in defining program goals, objectives, accomplishments, and problem areas.
- Enters all needed delivery orders for department in PPATS. Some examples of types of requests include SOW's, vendor contracts and consulting contracts.
- Website editor for the department.
- RFP scoring panelist- review in depth proposals for potential vendor/clients.
- APPE 4 year pharmacy student onboarding- Responsible for 6 week rotations for many students from the UK school of Pharmacy and overseeing their curriculum with the department.
- Team lead for RECT presentations as requested and compiling bi-annual slides.
- Research trends in Medicaid in regards to non-medical factors that can influence health outcomes ie; social or economic determinates.
- Compiled data from multiple sources into meaningful reports that can be used by senior management team members.
Medicaid Specialist III
Department of Medicaid Services-Member Services
01.2012 - 04.2019
- Analyzing update requests from call center representatives and process as needed. -Managed Care reports(MCO)- 834 Hippa Capitation reports, 200 Daily reports, 220 Newborn reports
- 250 and 230 Error reports
- Responsible for analyzing, logging and delegating assignments to other staff members for completion. -Policy advisor for supervisors and management -Identify system issues and meet with department heads to discuss potential challenges and solutions -Systems advisor for new and current staff -Conduct review of call center knowledge within department and meet with management to discuss any performance concerns and follow up with additional training to staff as needed -Hiring actions- Review applications, interviewing and selection of potential hires -Expert knowledge in the navigation of multiple programs/systems
- Examples: MMIS, Benefind, CRM and historically KAMES AND GUI
- Interpreted state guidelines pertaining to eligibility determination procedures to determine member benefits and provider additional resources if needed.
Medicaid Specialist I
Department for Medicaid Services
Frankfort, KY
12.2008 - 12.2011
- Answered incoming calls from Medicaid recipients and provided assistance with eligibility inquiries, billing questions, and other customer service related issues.
- Maintained accurate records of customer interactions for future reference.
- Performed follow-up calls as necessary to ensure satisfactory resolution of customer inquiries.
Call Center Rep
First Health (Medicaid contract)
07.2005 - 11.2008
- Call center representative for Kentucky Medicaid member services -Take incoming calls regarding various member issues and either answer questions based on policy knowledge or escalate to the state for further inquiry.
Provider Enrollment/Claims Specialist
03.2004 - 07.2005
- Review provider enrollment applications and misc forms for KY Medicaid and approve or deny based on required documentation -Maintain provider files and update as needed via GUI (State system) -Outreach to Medicaid provider via telephone, email or fax to request updated information or get correction as needed to process applications -Reviewed, approved, and denied claims for payment
Education
High School Diploma -
Western Hills High School
Frankfort, KY05-2003
Skills
- Policy Analysis
- Healthcare Knowledge
- Eligibility Determination
- Interviewing Techniques
- Effective Communication Skills
- Knowledgeable in multiple Medicaid systems obtained through 20 years within the department
References
- Commissioner Lisa Lee, 502-330-7879
- Jill Hunter, 859-421-6380
- John Hoffman, 502-564-2574
- Jamie Redmon, 502-682-4139
- LeeAnna Trainer, 502-320-9427
Timeline
Medicaid Specialist III
Department for Medicaid Services-Pharmacy Policy
04.2019 - Current
Medicaid Specialist III
Department of Medicaid Services-Member Services
01.2012 - 04.2019
Medicaid Specialist I
Department for Medicaid Services
12.2008 - 12.2011
Call Center Rep
First Health (Medicaid contract)
07.2005 - 11.2008
Provider Enrollment/Claims Specialist
03.2004 - 07.2005
High School Diploma -
Western Hills High School
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