Shakiya Jordan
Orange Park,FL
Summary
Resourceful Medicaid Eligibility Specialist known for high productivity and efficiency in task completion. Skilled in navigating complex eligibility criteria, maintaining accurate client records, and interpreting federal and state policy updates. Excel at communication, problem-solving, and time management, ensuring seamless operation within fast-paced environments. Efficient professional in government program administration. Specialize in eligibility determination, case management, and regulatory compliance.
Overview
14
14
years of professional experience
Work History
Medicaid Eligibility Specialist
Centauri Health Solutions
Atlanta, US
06.2022 - Current
- Provides lead direction and/or training to a unit of workers determining eligibility of applicants and recipients for public assistance programs
- Provides support to supervisor with unit operations and coverage
- Performs interactive interviews to elicit eligibility information, obtain and/or verify financial, employment, tax and personal demographic information and identify need for public assistance programs
- Assists in the development and implementation of procedures for public assistance programs
- Analyzes financial and eligibility information to determine initial or continuing eligibility for multiple aid programs
- Explains regulations, rules and policies to clients and apprises them of their rights, responsibilities and eligibility for participation
- Ensures accuracy and completion of application and declaration forms
- Resolves discrepancies by securing documentation, medical records and confirmation from other agencies
- Enters and retrieves numerical and narrative data, and issues benefits from an automated computer system
- Determines the level of benefits to which the client is entitled by making complex mathematical computations and/or complex computer entries
- Reviews and interprets information provided on a variety of forms both by the client and third parties to assist with eligibility determination
Customer Service Representative
Humana
Montgomery, AL
05.2019 - 11.2022
- Developed strong relationships with customers by providing personalized assistance and support.
- Provided beneficiaries with information about plan benefits and eligibility determinations.
- Answered incoming calls from Medicare beneficiaries, providing them with information regarding their benefits.
- Created documents such as letters, emails, or forms as needed for customer service purposes.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Answered questions and responded to inquiries to deliver high level of service to patients.
- Participated in training sessions designed to increase understanding of new policies or procedures related to enrollment processes.
Appeals & Grievances Analyst
L.A Health care solutions
Atlanta, GA
11.2020 - 06.2022
- Company Overview: (contract)
- Process early state appeals and or grievances to work down backlog of several thousand
- Identify and categorize whether item is appeal or grievances
- Work out of compliance cases
- (contract)
Radiology Patient Services Coordinator
University of Kentucky
Atlanta, GA
12.2014 - 05.2020
- Worked with multiple programs APM, SYNGO, AEHR, SCM, and SHARE POINT
- Scheduled radiology procedural test
- Assisted with order protocol delivery, two day order prep, protocol prep
- Provide clerical support, patient registration, and customer service
- Maintain and process the visitor schedule
- Communicate with patients, visitors, and monitor daily status reports
- Prepared daily reports on registration activities, highlighting areas for improvement.
- Reported liabilities and risk management concerns to supervisor for review.
- Facilitated patient registration, verifying all required documentation is collected and filed properly.
Chat Customer Service Rep/ Escalations Supervisor
Home Depot
Kennesaw, GA
09.2010 - 04.2014
- Provided quality professional customer service that consistently meets or exceeds Company standards of excellence and customer expectations
- Answered inbound calls from customers, quickly assess customer needs and proactively provides solutions
- Provided superior customer service while handling inbound calls for order placement and product inquiry
- Documented details of customer interaction into system while on the computer
- Drove repeat business by providing, excellent service, accurate and thorough product and service knowledge
- Kept customers informed on the status of their order, reconciles errors in a cost effective manner, resolves post-order issues such as returns and follows up to ensure all customer needs are fulfilled
- Met or exceeded scorecard requirements for productivity, schedule adherence, quality and attendance
- Completes assignments accurately despite a large workload
Education
GED -
Muhlenberg Career Development Center
Greenville, KY12-2006
Skills
- Interviewing techniques
- Application processing
- Medicaid
- Policy interpretation
- Eligibility determination
- Reliability
- Excellent communication
- Multitasking Abilities
- Problem-solving
- Schedule management
References
References available upon request.
Timeline
Medicaid Eligibility Specialist
Centauri Health Solutions
06.2022 - Current
Appeals & Grievances Analyst
L.A Health care solutions
11.2020 - 06.2022
Customer Service Representative
Humana
05.2019 - 11.2022
Radiology Patient Services Coordinator
University of Kentucky
12.2014 - 05.2020
Chat Customer Service Rep/ Escalations Supervisor
Home Depot
09.2010 - 04.2014
GED -
Muhlenberg Career Development Center
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