JOYCE MOSS
Philadelphia,Pennsylvania
Summary
Direct Support Staff
To seek a responsible position in that will allow me to use my experience in Managed Care organizations, Education, Community Services, Health care, Behavioral Health . Compassionate Early Interventionist skilled in preventing development delays and collaborating with family members to foster successful interventions. Aiming to utilize eight years of participant development assessment knowledge to add value to the RHA - mission.
Overview
13
13
years of professional experience
Work History
Early Intervention Service Coordinator
Merakey
Philadelphia, PA
02.2024 - Current
- Collaborated with other professionals, including physicians, psychologists, speech therapists, teachers and social workers to ensure that appropriate interventions were provided.
- Conducted outreach activities designed to increase awareness about Early Intervention Services among parents and caregivers in the community.
- Conducted developmental screenings, assessments, and evaluations of children birth to three years old.
- Participated in transition planning from Early Intervention Services into Preschool Special Education programs when applicable.
Grievance and Appeals Specialist
AmeriHealth Caritas
Philadelphia, PA
12.2015 - Current
- Provide support and assistance with completing various daily living activities while encouraging independence and preserving dignity, regardless of ability
- Securing necessary documentation; informing appropriate people; encouraging individuals to carry our recommendations; and ensuring completion and monitoring of recommendations
- Present a positive role model and provide counseling to individuals to help them more effectively deal with matters such as personal problems, personal values, interpersonal relationships, and vocational responsibilities, where applicable.
Adjudication Appeals Specialist
Maximus -Federal
Philadelphia, PA
08.2021 - 10.2023
- Provided excellent customer service support for inbound and outbound calls
- Research and investigate members and providers Medicaid, and Medicare expedited, standard appeals, claims and dispute grievances
- Educate members and providers about the appeal process, create scheduling and outcome letters
- Maintain compliance with standards as dictated by the state and federal entities.
Data entry appeals
08.2020 - 08.2021
- Identified reasons behind denied claims and worked closely with the Marketplace to promote resolutions
- Acted as intermediary between insurance companies and customers, including researching and assessing information to determine validity of claims
- Analyzed insurance organizational structures, business and intermediaries; studied basic documents, including common clauses, policies and insurance contracts.
Service Coordinator/ Case Manager
Maximus
Philadelphia, PA
09.2019 - 08.2020
Manage State and Medicaid Home and Community-Based Waiver Programs
09.2017 - 06.2019
- Assist Leadership in the monitoring and successful achievement of program goals and objectives
- Ensure compliance of program, services and staff regarding appropriate regulations
- Monitor HCBS contracts within the region of responsibility and serve as operations liaison with assigned subcontractors and program monitors
- Initiate plan development, monitor and provide ongoing oversight of consumer service plans, transitional services, eligibility requirements and individual progress in Medicaid Home and Community Based Waiver Programs to ensure timely and effective services for Advocate for and represent consumers who request support and for those who are unable or incapacitated to advocate for themselves
- Participate in activities advocating systems changes, promoting and providing community education as assigned
- Create and enhance relationships and services between community agencies.
01.2011 - 01.2017
- Responsible: complete assessments, process both referrals, authorization packets, ensuring clients are receiving prescribed hours, distributing caseloads, participation in team meetings, utilized Care logic data base, excel, to update client tracking, coordinate services with agencies, schools, staff and parents
- Guided and assist individuals in gaining access to necessary medical rehabilitative and social services
- The Case Manager will coordinate and facilitate access to care, and maintained participants health insurance eligibility with the Department Of Public Welfare and conduct home visits as needed, participated discharge planning.
Direct Support Staff
RHA/ Growth Horizons
Montgomery, PA
- Organized leisure time activities such as arts and crafts projects, group games, outings.
- Facilitated communication between clients, families, and other healthcare professionals.
- Maintained accurate records including incident reports, progress notes, medication logs.
Clinical Case Manager
Carson Valley Children Aid
Philadelphia
- Provided enrollment services for applicants who aging or with physical disabilities applying for Community Health Choice services
- To collect, process applications with the Department of Public Welfare, and enter data into secured data base within specific timeline.
Service Coordinator/ Case Manager
Pennsylvania Home Care Assistance Agency
Huntington Valley, PA
- Provided enrollment services for applicants who aging or with physical disabilities applying for Community Health Choice services
- To collect, process applications with the Department of Public Welfare, and enter data into secured data base within specific timeline.
Education
Associate in Arts (A.A.) in Early Childhood Education (AECE) -
Community College of Philadelphia
05.1998
Associate in Arts (A.A.) in General Studies -
Community College of Philadelphia
Skills
- Case Management
- Client Requirements
- Transporting Residents
- Child development knowledge
- Service Coordination
- Assessing and developing service plans
- Progress Monitoring
- Faculty communication
- Social-emotional learning
- Individualized support
- Interdisciplinary Collaboration
- Data collection and analysis
- Medical terminology expertise
References
References available upon request
References
References available upon request.
Timeline
Early Intervention Service Coordinator
Merakey
02.2024 - Current
Adjudication Appeals Specialist
Maximus -Federal
08.2021 - 10.2023
Data entry appeals
08.2020 - 08.2021
Service Coordinator/ Case Manager
Maximus
09.2019 - 08.2020
Manage State and Medicaid Home and Community-Based Waiver Programs
09.2017 - 06.2019
Grievance and Appeals Specialist
AmeriHealth Caritas
12.2015 - Current
01.2011 - 01.2017
Direct Support Staff
RHA/ Growth Horizons
Clinical Case Manager
Carson Valley Children Aid
Service Coordinator/ Case Manager
Pennsylvania Home Care Assistance Agency
Associate in Arts (A.A.) in Early Childhood Education (AECE) -
Community College of Philadelphia
Associate in Arts (A.A.) in General Studies -
Community College of Philadelphia