Sylvia Anderson
Manor,USA
Summary
Resourceful Medicaid Eligibility Specialist with expertise in eligibility determination, case management, and regulatory compliance. Skilled in claims processing, policy interpretation, and dispute resolution, facilitating optimal outcomes for clients. Proven ability to navigate complex benefit structures while maintaining accurate records and ensuring compliance with federal and state policies. Committed to delivering quality service, fostering teamwork, and driving continuous improvement.
Overview
42
42
years of professional experience
Work History
PBA III
Parallon
Austin, Texas
05.2023 - Current
- Evaluated client eligibility for Medicaid programs and services.
- Reviewed applications and supporting documents to determine applicant's eligibility for Medicaid benefits.
- Reviewed and processed applications for accuracy and completeness.
- Guided clients through the Medicaid application process and requirements.
- Educated clients about available benefits and resources for assistance.
- Documented client interactions and eligibility determinations to ensure compliance and accuracy.
- Conducted follow-up communications to resolve outstanding eligibility issues.
- Participated in training sessions to stay updated on policy changes and regulations.
- Compiled and documented information regarding applicant's income, assets, insurance coverage and other relevant data.
- Responded promptly to inquiries from applicants, providers and other stakeholders concerning Medicaid services.
- Processed requests for changes in existing Medicaid cases.
- Assisted individuals with the completion of complex paperwork related to their application process.
- Maintained up-to-date knowledge of state and federal regulations pertaining to Medicaid eligibility.
- Updated case management systems with current information regarding client status.
- Collaborated with other departments within the organization in order to resolve issues relating to Medicaid eligibility requirements.
- Attended training sessions, seminars and workshops related to Medicaid programs.
- Verified accuracy of applicant's financial information against third-party sources such as employers, banks or government agencies.
- Performed initial eligibility screenings for Medicaid applicants to assess program qualification.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Assisted in navigating complex disability benefits and application processes.
- Assessed client needs to determine eligibility for disability services.
- Coordinated with healthcare providers to gather necessary documentation.
- Examined legal issues related to disability determinations including employment status, onset date of disability, duration of illness.
- Monitored changes in claimants condition over time through periodic reviews.
- Assessed eligibility requirements for government benefits related to disability status.
- Answered questions and responded to inquiries to deliver high level of service to patients.
- Gathered and analyzed patient information to determine special program eligibility.
- Attended meetings with physicians and other healthcare professionals to discuss cases.
- Processed insurance verifications and authorizations to ensure coverage of services.
- Stayed current on community-based resources and services useful to patients.
- Screened patients for eligibility for state, local and federal assistance programs.
- Screened patients for eligibility for state, local and federal assistance programs.
Registrar
St. David's HealthCare/ Business Office
Austin, US
11.2001 - 03.2008
- Registered women in labor and delivery, facilitating smooth admission process for mothers and newborns.
- Registered patients in main admissions and emergency department, ensuring accurate documentation and efficient processing.
- Called insurance companies to obtain pre-authorization codes for procedures, hospital stays, surgeries, and imaging, supporting timely patient care.
- Verified insurance coverage for patients via phone and websites.
- Also used Passport to verify government programs such as Medicaid, Amerigroup and Superior Health Plan.
- Explained EOB documents to patients, clarifying coverage details and addressing questions.
- Registered patients using Medi-Tech system in a fast-paced environment.
Medical Billing Specialist
Southwest Regional Cancer Center
Austin, US
11.1998 - 10.2001
- Compiled and organized billing statements for timely submission to insurance providers.
- Conducted medical coding to ensure accurate bill preparation.
- Resolved patient billing issues at front desk, enhancing patient satisfaction.
Head Teller/Customer Service Representative/store manager
Money Bags Check Cashing Store
Austin, US
10.1997 - 11.1998
- Facilitated customer transactions by efficiently issuing money orders, enhancing customer satisfaction.
- Processed payroll checks for customers, ensuring timely access to funds.
- Processing money wires such as Money Gram and several more.
- Ensured accurate preparation of bank deposits to maintain financial integrity.
- Balancing all financial records for the store using Excel spreadsheets.
- Supervised employees, prepared schedules, and delegated tasks to maintain operational efficiency.
Head Cashier/ Cash office assistant Manager
Drug Emporium Pharmacy
Austin, US
03.1987 - 05.1989
- I balanced financial records for all the cash registers in the store.
- Prepared bank deposits for store to ensure accurate financial management.
- Assisted customers with in-store purchases to enhance shopping experience.
- Provided customer service support to resolve inquiries and issues.
Head Cashier/Customer Service
Montgomery Ward
Austin, US
06.1984 - 02.1986
- Assisted customers with merchandise selection and processed transactions at the register.
- Delivered customer service by addressing inquiries and resolving issues to enhance customer satisfaction.
- Balanced all cash registers and prepared bank deposits in cash office, ensuring accuracy and compliance.
Education
High school diploma -
Reagan High School
Austin, TX05-1985
Skills
- Data management
- Medical records
- Administrative support
- Medicaid eligibility
- HIPAA compliance
- Document management
- Disability eligibility assessment
- Customer service
- Front desk
- Clerical experience
- Office experience
- Record keeping
- Multi-line phones
- Typing
- Word processing
- Filing
- Microsoft Word
- Organizational skills
- Task prioritization
- Multitasking Abilities
- Problem-solving
- Time management
- Prioritization
- Analytical thinking
- Workflow optimization
Personal Information
Work Permit: Authorized to work in the US for any employer
Languages
English
Full Professional
Spanish
Professional
Timeline
PBA III
Parallon
05.2023 - Current
Registrar
St. David's HealthCare/ Business Office
11.2001 - 03.2008
Medical Billing Specialist
Southwest Regional Cancer Center
11.1998 - 10.2001
Head Teller/Customer Service Representative/store manager
Money Bags Check Cashing Store
10.1997 - 11.1998
Head Cashier/ Cash office assistant Manager
Drug Emporium Pharmacy
03.1987 - 05.1989
Head Cashier/Customer Service
Montgomery Ward
06.1984 - 02.1986
High school diploma -
Reagan High School