Michelle Sessoms

Conduct reviews of Local Department of Social Services (LDSS) cases in Supplemental Nutrition Assistance Program (SNAP) and Medicaid as mandated by the US Department of Agriculture (USDA), Food and Nutrition Service (FNS) and US Center for Medicare and Medicaid (CMS) to evaluate LDSS performance and determine Virginia's error rate compared to other states. Identify procedural misunderstandings by LDSS, describe performance trends, discrepancies in policy and refer questions of program abuse for fraud investigation. Reach accurate and definitive conclusions regarding policy and procedural compliance as well as benefit accuracy and convey these in a clearly written narrative Findings Report to local agencies, state policy units and federal partners. Thoroughly evaluate case records for timeliness and accuracy of benefits through case record reviews, third-party inquiries and in-depth personal interviews with clients. Evaluate all information using QC procedures and program policy knowledge to reach a sound/accurate decision on each review. Enter and record data in Quality Control system (Q5i). Independently manage a deadline-oriented workload with high degree of accuracy. Ability to interpret and apply complex state and federal regulations and procedures. Assist QC supervisor with training new Reviewers and mentoring. Assist co-workers with CAPER/Negative Review processing questions and technical issues. QC contact in supervisor's absence.

Provided technical assistance and training on prevention, detection, investigation and prosecution of public assistance fraud. Conduct local agency Fraud Program Compliance reviews and complete quality reviews of investigations in the Fraud Module in VaCMS. Consult within VDSS and other state agencies, as appropriate, to enhance fraud investigations. Respond to allegations from the public within specified time frame, track fraud referrals and follow up for resolution. Receive USDA Whistleblower complaints from FNS and forward to appropriate local agencies; forward updated reports to FNS regarding outcome. Receive, forward and track referrals from Quality Control to local agencies and request follow-up within specified time frame. Respond to out of state PARIS matches. Monitor Multiple Card Replacement reports and communicate to local agencies regarding cases with excessive replacements. Assist with system testing for VaCMS releases and new system requirements.

Interpret and apply program policies and procedures for the processing of applications and renewals, particularly Families & Children Medicaid, FAMIS and Aged, Blind and Disabled Medicaid. Assisted local agencies with the processing of overdue Medicaid applications and renewals. Communicated clearly, concisely and effectively with both internal and external customers in order to obtain required financial and non-financial verifications necessary to determine eligibility and ensure the timely and accurate delivery of benefits to eligible individuals. Completed case comments in VaCMS with actions taken on case, and uploaded verifications as needed. Completed special projects such as researching specific agency overdue applications to determine reason for non-compliance. Responsible for monitoring, updating and transferring application received in the Central Office My Work Space inbox which failed to be routed to appropriate agency due to incomplete address, registration or file clearance. Assisted co-workers with eligibility processing questions, procedures and technical issues within VaCMS by providing policy clarification and technical assistance. Demonstrated problem solving skills by troubleshooting case errors within VaCMS that prohibited completion of cases. Planned, prioritized, and managed multiple projects or assignments with minimal supervision. Submitted progress report to unit supervisor regarding work assignments and tracking of applications and renewals. Assisted The Division of Enterprise Systems as needed by utilizing word processing skills in order to complete Spanish translations of notices and forms within the VaCMS.

Responsible for the determination and redetermination of eligibility of individuals and families for SNAP, Families & Children, FAMIS and Aged, Blind and Disabled Medicaid benefit programs through interview and obtaining required information. Explained benefit programs and customer rights and responsibilities. The work was performed within established policies, procedures and guidelines. Determined eligibility for assistance and benefit levels using automated systems and manual methods. Monitored cases for changes in recipient circumstances and implemented changes to reflect appropriate benefit levels. Provided customers with community resource information as needed. Assisted new workers in the use of VaCMS, MMIS and ADAPT.

Responsibilities included but were not limited to serving in a supervisory capacity in the absence of a unit supervisor. Provided administrative and programmatic supervision of staff. Submitted agency statistical reports for monthly Medicaid and EAP applications to agency director. As a Senior Benefit Specialist, I monitored and reviewed cases to include quality assurance and case management, provided policy clarification, guidance and technical assistance to all Benefit Specialists. Pulled pending applications and renewal reports for compliance, requested updates from workers. Assisted new staff with case management issues. Reviewed, certified and authorized all Medicaid cases in the VaCMS (Virginia Case Management System) for new staff. Assisted in the internal training of staff in the use of VaCMS and CPU processing of non-FFM cases. Determined eligibility for all Energy Assistance applications to include Cooling, Fuel and Crisis assistance until part-time EA worker was hired. Direct supervision of part-time EAP worker. Responded to customer and vendor issues in a timely manner by assessing and resolving any errors. Maintained and tracked agency budget for Dominion Energy Share program; evaluated applications and submitted requests for payments. Completed reconciliation of budget on a weekly basis to ensure approvals were within allotted budget. The work was performed within established policies, procedures, and guidelines. Sought assistance for difficult or unusual situations by contacting regional specialists and consultants. Determined eligibility for public assistance and benefit levels using automated systems for new and ongoing customers. Monitored cases for changes in recipient circumstances and updated information to reflect benefit level. Evaluated employment status and potential sources of income; explained customer responsibilities, rights, and program availability. Referred customers to service workers as the result of overall assessment of the situation. Identified possible fraud and made appropriate referrals. Computed assistance plans; determined the number of allowances for special circumstance items such as household equipment. Provided applicants or recipients with information on where they can go for services needed. Explained a variety of programs under the social services umbrella such as employment services, child support and childcare services. Completed Fraud investigations referred to by eligibility and service workers, outside individuals and PARIS matches. Assisted with Spanish speaking individuals as needed. Systems used: VaCMS, ADAPT, MMIS, SVES, SPIDeR, UNISYS, FDTS and Data Warehouse.

Responsible for determination and redetermination of eligibility of individuals and families for SNAP, Families and Children Medicaid, FAMIS and Aged, Blind and Disabled Medicaid benefit programs by using established policies, procedures and guidelines. Completed telephone and face-to-face interviews for assistance. Obtained required verifications to determine eligibility for assistance and benefit levels using automated systems and manual methods. Explained benefits programs and customer rights and responsibilities. Responsible for intake applications, ongoing cases and processing of changes timely. Utilized state systems to verify sources of income, identity and possible open cases at other localities, assisted co-workers with Spanish speaking customers. Referred customers to service workers and reported possible fraud.

Assisted uninsured and underinsured patients in securing medical coverage by screening referred patients in the hospital, over the telephone and completing home visits. Screened patients for Emergency Medicaid, Families & Children, FAMIS, Aged, Blind and Disabled Medicaid and SSA/SSI Disability benefits. Assisted with the application process through successful approval. Submitted appeals for denied applications when applicable. Documented company and hospital database with actions taken on accounts in a timely manner. Verified private, state and federal insurance coverage by utilizing EVS, Emdeon, Rocondo and VA Medicaid Web Portal insurance verification systems. Updated active/approved insurance information in hospital billing system and initiated billing. Maintained current caseload according to protocol. Followed current HIPAA guidelines. Traveled to various locations for outside training, facility coverage and home visits. Communicated effectively with supervisor, clients, hospital staff, social services and co-worker.

Assisted customers in person and over the telephone with inquiries concerning the status of their cases. Provided information and assistance regarding obtaining and completing appropriate SNAP, Medicaid, TANF, EAP applications and forms. Reviewed applications and verifications submitted at the front desk and entered into local tracking system for an appointment to be scheduled. Entered customers into system to be seen for emergency services for pending eviction, utility disconnections and homelessness. Completed correspondence for Child Protective Services concerning CPS reports. Checked customers in for appointments, copied, stamped and logged incoming documentation and verifications received at front desk. Answered and directed incoming switchboard calls to assigned case worker or department. Distributed keys for county vehicles. Followed closing procedures for the front desk and receptionist area. Assisted with purging case files yearly.