Hard-working with exceptional experience leading teams, delivering results and exceeding expectations. Creative and motivated leader adept at utilizing exceptional design and planning strengths to accomplish complex projects. Skilled in teaching new concepts and best practice strategies with the Ability to plan, Initiate and with Exceptional organization skills and ability to multi-task.
Stop production if serious product is not workable task.
Review and update standard operating procedures or quality assurance manuals.
Monitor performance of quality control systems to ensure effectiveness and efficiency.
Review quality documentation necessary for regulatory submissions.
Analyze quality control test results and provide feedback and interpretation to production management or staff.
Verify that materials, and finished products meet established requirements. Oversee workers including supervisors, workers engaged in tasks activities. Instruct staff in quality control and analytical procedures.
Direct the tracking of regularly reported quality control data.
Participate in the development of product specifications.
Identify quality problems or areas for improvement and recommend solutions.
Collect and analyze production samples to evaluate quality.
Produce reports regarding nonconformance of tasks or processes, daily production quality, root cause analyses, or quality trends.
Communicate quality control information to all relevant organizational workers.
Monitor development of new products to help identify possible problems for mass production.
Identify critical points in the manufacturing process and specify sampling procedures to be used at these points.
Create and implement inspection criteria or procedures.
Document criteria for RSA.
Review statistical studies, technological advances, or regulatory standards and trends to stay abreast of issues in the field of quality control.
Instruct workers on quality guidelines, and ways to eliminate deficiencies task that have been sent out.
For the SME ensure the facts and details are correct so that the project deliverable will meet the needs of the clients, policies, and standards with the best practices of delivery.
For supervisor assistant ensuring that the employees are productive and being efficient with their task that comply with the policies and standards.
Training of new analyst that hits the floor.
Reporting to the senior management and reporting of any issues.
Determine eligibility of persons applying to receive assistance from government programs and agency resources such as Medicaid. Medicare, Food Stamps, TANF, WIC and more.
Review task to see if the cases are workable. Work changes and renewals application for clients with Medicaid for the state Georgia.
Work Pathway Applications
Verify Liquid resources like checking and saving account, vehicle, trust account and more.
Different expenses and deductions.
Run different interfaces like DOL-WG, WN (Worker number), FD, UB (Unemployment ) NHNFD
Use a different system Gateway to run the case and make case notes for the state worker to look at the case.
Performs quality assurance
reviews of long-term care
and non-long-term care
cases, to ensure accuracy and
compliance with applicable
Federal and State regulations.
Communicate knowledge
gaps to team members and
facilitate ongoing training and
coaching.
Communicate expectations &
guidelines to team members.
Review Long Term Car Make
recommendations for
improving QA and
automation processes and
best practices based on
analysis.
Interpret policies,
procedures, rules,
regulations, and standards
to communicate on a
complex level with others to
exchange or verify
information.
i.e, Home and Community Based
Services/ Nursing home/
Assisted Living cases, and an in-
depth knowledge of the
Medicaid Waiver.
Identify errors and provide
feedback to team reviewer to
ensure correct process is
followed.
Complete a QA Return sheet
detailing questions or areas
of improvement and share
with reviewer.
Provide eligibility services
to clients of the
department various
assistance programs and
provide a broad range of
client services aimed at
maintaining or achieving a
client full potential for
self-direction, self-
reliance, and independent
living.
Research, verify and
evaluate statements and
documents submitted by
clients and other factors
to ensure compliance with
program eligibility
requirements.
Review and process
related tasks assigned.
Make all available case
updates with a technical
knowledge of general
authorization principles
and standard, working
knowledge of State
guidelines and policy
related to utilization
management.
Input and update data
collection fields and
screens with all available
and up-to-date
information using scanned
documents, Interfaces,
Income, and
demographics documents
provided.
Conduct and process long-
term services and
supports (LTSS)
applications/ prioritizing
task assigned and meeting
time sensitive deadlines.
Reviewed and analyzed
financial and eligibility
information.
Maintained current
knowledge of policies and
procedures for efficiency.
Typed a detailed journal
entries of actions taken on
a case.
Utilized Medicaid policy
and procedure for
accurate determination
and timely processing.
Utilize database and
written materials (QRG) to
look up information.
Followed all procedures
and applied knowledge of
HPAA, PII and PHI Act to
avoid violations.
performed page-to-page
review and analysis to
determine eligibility.