Sarah Bird
Schenectady,NY
Summary
Since 2009, I have worked in a diverse and consistently challenging environment for the health insurance industry. I specialize in policy and procedures interpretation pertaining to Health Program reimbursement methodologies, and development of government funded health services programs. This includes extensive analysis of eligibility determinations and health equities.
Overview
13
13
years of professional experience
Work History
MEDICAL ASSISTANCE SPECIALIST 1 (GRADE 18, MANAGEMENT)
NYS DEPARTMENT OF HEALTH - OFFICE OF HEALTH INSURANCE PROGRAM, THIRD PARTY LIABILITY
06.2022 - Current
- Management, Supervision, and Administration of staff in Medicaid or other public health insurance programs
- Perform program reviews of Medicaid providers, demonstration projects, and automated systems
- Provide technical assistance to stakeholders in developing operational procedures, instructions, and guidelines to support the implementation of enrollment and eligibility activities and ensure operational compliance
- Data compilation, analysis, reporting, and discrepancy resolution, resolving department workflow needs; setting up project and training related written material according to state/federal policy, procedures, regulations, and laws
- Data mining, extraction, and utilization of SQL (Structured Query Language), Microsoft Access, and other research narrative/project management software
- Establishing, revising, and/or assisting with the implementation of program policies and procedures to meet treatment and/or regulatory requirements of health care
- Analyzing State and/or federal health insurance laws to inform the development or modification of program operations, including the creation, editing, copywriting, project management of department and agency work instructions, policies, training initiatives according to current and updated local, state, federal, and internal practices
- Application evaluation, Research, correspondence, coverage modification, research, documentation, and troubleshooting of NYSOH Back Office, WMS (Welfare Management System), SOLQ, COLD, eMedny for internal controls implementation, quality assurance adherence, determination of eligibility for premium reimbursement, managed care enrollment, and authorization of coverage and participation in Medicaid, Medicare, supplemental, special population, private and Government Funded Health Insurance programs
- Establishing tracking mechanisms for the reimbursement and financing of health care services, including rate-setting, development of capitation reimbursement methodologies, and development of fee schedules
- Training, coaching, counseling of staff unit projects, quality control, and assigned tasks
- Use of Microsoft programs to include Outlook, Work, Excel, and Calendar Tracking.
MEDICAID ELIGIBILITY EXAMINER 3
NYS DEPARTMENT OF HEALTH - OFFICE OF HEALTH INSURANCE PROGRAM, THIRD PARTY LIABILITY
08.2016 - 06.2022
- Management, Supervision, and Administration of staff in Medicaid or other public health insurance programs
- Researching cases for status, eligibility for reimbursement, payment history, cost effectiveness, quality assurance, auditing, documentation, and compliance with departmental standards, upholding HIPAA, PHI, and CMS policy, laws, and procedures
- Data compilation, analysis, reporting, and discrepancy resolution, resolving department workflow needs; setting up project and training related written material according to state/federal policy, procedures, regulations, and laws
- Data mining, extraction, and utilization of SQL (Structured Query Language), Microsoft Access, and other research narrative/project management software
- Establishing, revising, and/or assisting with the implementation of program policies and procedures to meet treatment and/or regulatory requirements of health care
- Analyzing State and/or federal health insurance laws to inform the development or modification of program operations, including the creation, editing, copywriting, project management of department and agency work instructions, policies, training initiatives according to current and updated local, state, federal, and internal practices
- Application evaluation, Research, correspondence, coverage modification, research, documentation, and troubleshooting of NYSOH Back Office, WMS (Welfare Management System), SOLQ, COLD, eMedny for internal controls implementation, quality assurance adherence, determination of financial eligibility, premium reimbursement, managed care enrollment, and authorization of coverage and participation in Medicaid, Medicare, supplemental, special population, private and Government Funded Health Insurance programs
- Establishing tracking mechanisms for the reimbursement and financing of health care services, including rate-setting, development of capitation reimbursement methodologies, and development of fee schedules
- Training, coaching, counseling of staff for unit projects, quality control, and assigned tasks
- Use of Microsoft programs to include Outlook, Work, Excel, Calendar Tracking, eMedny, NYS Marketplace, and management of timecards.
TEMPORARY PROGRAM COORDINATOR
ALBANY STRATTON VA MEDICAL CENTER
01.2016 - 08.2016
- Supervisor support in the determination of state/federally funded pharmacy copays, research donation allocation, and data analysis for Veteran's benefit program eligibility
- Researching cases for status, eligibility for reimbursement, payment history, cost effectiveness, quality assurance, auditing, documentation, and compliance with departmental standards, upholding HIPAA, PHI, and CMS policy, laws, and procedures
- Data compilation, analysis, reporting, and discrepancy resolution, resolving department workflow needs; setting up project and training related written material according to state/federal policy, procedures, regulations, and laws
- Data mining, extraction, and utilization of SQL (Structured Query Language), Microsoft Access, and other research narrative/project management software
- Establishing, revising, and/or assisting with the implementation of Veteran's Affairs program policies and procedures to meet treatment and/or regulatory requirements of health care
- Analyzing State and/or federal laws to inform the development or modification of program operations, including the creation, editing, copywriting, project management of department and agency work instructions, policies, training initiatives according to current and updated local, state, federal, and internal practices
- Acting as liaison for purchasing orders/invoices, responsible for written materials and training of staff for project and onboarding carry out
- Arrangement of travel for Veteran's Administration staff and prospective employees
- Use of Microsoft Office Outlook, Word, Excel, Calendar Tracking, VISN systems for tracking of payment and remittance
- Collaboration with Human Resources for arranging and carrying out employee training workshops, benefits verification, expense reports, and voucher disbursement.
PROVISIONAL MEDICAID ELIGIBILITY EXAMINER 1
NYS DEPARTMENT OF HEALTH
07.2014 - 12.2015
- Supervisor support in the determination of state funded Medicaid/Medicare/supplemental program eligibility
- Researching cases for status, eligibility for reimbursement, payment history, cost effectiveness, quality assurance, auditing, documentation, and compliance with departmental standards, upholding HIPAA, PHI, and CMS policy, laws, and procedures
- Data compilation, analysis, reporting, and discrepancy resolution, resolving department workflow needs; setting up project and training related written material according to state/federal policy, procedures, regulations, and laws
- Data mining, extraction, and utilization of SQL (Structured Query Language), Microsoft Access, and other research narrative/project management software
- Establishing, revising, and/or assisting with the implementation of program policies and procedures to meet treatment and/or regulatory requirements of health care
- Analyzing State and/or federal health insurance laws to inform the development or modification of program operations, including the creation, editing, copywriting, project management of department and agency work instructions, policies, training initiatives according to current and updated local, state, federal, and internal practices
- Training, coaching, counseling of staff for unit projects, quality control, and assigned tasks
- Use of Microsoft programs to include Outlook, Work, Excel, Calendar Tracking, eMedny, NYS Marketplace, and management of timecards.
LEAD CLAIMS EXAMINER
EMPIRE BLUE CROSS BLUE SHEILD
01.2012 - 07.2014
- Supervisor support in the determination of Managed Care Commercial Employer Sponsored, Medicaid/Medicare/supplemental contract Benefit eligibility and claim examination
- Researching claims for benefit level coverage status, eligibility for reimbursement, payment history, cost effectiveness, quality assurance, auditing, documentation, and compliance with departmental standards, upholding HIPAA, PHI, and CMS policy, laws, and procedures
- Data compilation, analysis, reporting, and discrepancy resolution, resolving department workflow needs; setting up project and training related written material according to state/federal policy, procedures, regulations, and laws
- Data mining, extraction, and utilization of SQL (Structured Query Language), Microsoft Access, and other research narrative/project management software
- Establishing, revising, and/or assisting with the implementation of program policies and procedures to meet treatment and/or regulatory requirements of health care
- Analyzing Commercial, State and/or federal health insurance laws to inform the development or modification of department operations, including the creation, editing, copywriting, project management of department and agency work instructions, policies, training initiatives according to current and updated local, state, federal, and internal practices
- Use of FACET, MACESS, UB04/CMS 1500 FORMS, Processing/examination/verification/internal authorization of institutional and provider office benefit claims and according to fee schedules and credentialing guidelines
- Providing quality assurance review for entry-level claims processors with respect to policy, procedure, and claims operations training
- Training, coaching, counseling of staff for unit projects, quality control, and assigned tasks
- Use of Microsoft programs to include Outlook, Work, Excel, Calendar Tracking, eMedny, NYS Marketplace, and management of timecards.
Education
Liberal Arts -
Schenectady County Community College
MEDICAL OFFICE ADMINISTRATION -
EARL C. CLEMENTS JOB CORPS ACADEMY
06.2007
Skills
- Over 13 years of experience in the health insurance industry from the start of the Affordable Care Act of 2009
- Vast understanding of State and Federal laws, rules, and regulations with concern to Medical Benefit distribution and comprehensive coverage
- Intuitive interpersonal skills
- Experience with commercial, state, and federally funded health insurance benefit programs, including Medicaid and Medicare, special populations, government funded, grant based supplemental programs
- FACETS System
- Technical writing using project templates and feedback; Ensure agency and organizational formatting is adhered to on project deliverables; correcting, editing, and modifying materials as necessary
- Review content of project materials and ensure proper word usage, consistency of language, tone, and flow of documents
- Collaboration with functional teams and organization staff in the design of documents and the update of terms, definitions, and processes outlined in documents
- Use of Microsoft programs Excel, Word, Microsoft, Access, PowerPoint, and Outlook
- Quality Assurance adherence practices related to data analysis, monitoring, reporting, research, and policy implementation
- Management System Software and staff supervision practices
Timeline
MEDICAL ASSISTANCE SPECIALIST 1 (GRADE 18, MANAGEMENT)
NYS DEPARTMENT OF HEALTH - OFFICE OF HEALTH INSURANCE PROGRAM, THIRD PARTY LIABILITY
06.2022 - Current
MEDICAID ELIGIBILITY EXAMINER 3
NYS DEPARTMENT OF HEALTH - OFFICE OF HEALTH INSURANCE PROGRAM, THIRD PARTY LIABILITY
08.2016 - 06.2022
TEMPORARY PROGRAM COORDINATOR
ALBANY STRATTON VA MEDICAL CENTER
01.2016 - 08.2016
PROVISIONAL MEDICAID ELIGIBILITY EXAMINER 1
NYS DEPARTMENT OF HEALTH
07.2014 - 12.2015
LEAD CLAIMS EXAMINER
EMPIRE BLUE CROSS BLUE SHEILD
01.2012 - 07.2014
Liberal Arts -
Schenectady County Community College
MEDICAL OFFICE ADMINISTRATION -
EARL C. CLEMENTS JOB CORPS ACADEMY