Karina Lira

Medicaid Customer Service (MCS) division, independently analyze applications, determine initial and/or ongoing eligibility and authorize benefits for Medicaid programs administered by the Medical Eligibility Determination Services (MEDS) office,

Apply complex federal and state eligibility regulations published in WAC and RCW to specific household circumstance resulting in accurate eligibility decisions.

Use and manage multiple interdependent electronic systems including but not limited to the Automated Client Eligibility System (ACES), HealthPlanFinder, ProviderOne, Audit Plus, Microsoft Office, SOLQ, Document Management Systems (DMS) and Employment Security Department (ESD).

Analyze, research and resolve complex eligibility issues applying proper rules and procedures with a high degree of independence.

Conduct interviews over the telephone, in person, and/or through written correspondence with clients, providers and/or third parties to obtain information for required documentation and verification to support program eligibility.

Review medical documentation to determine eligibility for the Alien Emergency Medical program.

Evaluate client eligibility for Washington Apple Health benefits and eligibility for Qualified Health Plan.

Assisted clients with accurate eligibility form, application and document completion for food benefits (SNAP & TANF) through Washington Connections.

Collaborated with community organizations to facilitate outreach and improve program access for underserved populations.

Maintained detailed records of client interactions, ensuring accuracy and confidentiality of sensitive information.

Assisted clients with scheduling doctors appointments.

Interviewed applicants and explained scope of different available benefits.

Supervised daily operations, ensuring adherence to safety and quality standards.

Trained and mentored team members on operational procedures and best practices.

Coordinated shift schedules, optimizing resource allocation for peak service periods.

Resolved customer complaints promptly, maintaining high satisfaction levels and loyalty.

Promoted a positive work environment through open communication and constructive feedback.