Kimberly Durham
Charlotte
Summary
Knowledgeable and dedicated customer service professional with extensive experience in healthcare industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
15
15
years of professional experience
Work History
Care Coordinator
Centene
Charlotte, NC
09.2021 - Current
- Coordinated care plans to enhance patient outcomes and streamline services across multidisciplinary teams.
- Managed patient assessments and ensured timely follow-up on care initiatives and referrals.
- Developed educational materials for patients to improve understanding of health management strategies.
- Facilitated communication between patients, providers, and community resources to optimize care continuity.
- Implemented process improvements to reduce barriers in accessing healthcare services for underserved populations.
- Analyzed patient data trends to identify opportunities for program enhancements and targeted interventions.
- Used company software and databases to maintain records of services performed and patient conditions.
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Developed strong relationships with community partners, facilitating referrals and collaboration on behalf of patients.
- Conducted regular evaluations of care plan effectiveness, making necessary adjustments based on feedback from patients and providers.
- Built strong relationships with clients to deliver emotional support and companionship.
- Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations.
- Educated patients on self-care strategies, promoting independence and empowering them to manage their health conditions.
- Assessed patient needs and connected them with appropriate resources to ensure optimal health outcomes.
- Monitored progress towards patient goals, adjusting care plans as needed to achieve desired results.
- Advocated for patients'' rights within the healthcare system, working diligently to address concerns or barriers to care.
Community Health Worker
Bright Health
Charlotte, NC
09.2020 - 03.2021
- Developed community outreach programs to enhance health education and awareness.
- Coordinated health screenings and immunization clinics within local neighborhoods.
- Conducted assessments to identify individual health needs and resource access barriers.
- Collaborated with healthcare providers to ensure continuity of care for patients.
- Connected families with necessary social services, alleviating barriers to healthcare access and improving quality of life.
- Built trust within diverse communities through cultural competency training, empathetic communication skills, and active listening techniques.
- Addressed patient concerns and provided support to vulnerable demographics.
- Participated in ongoing professional development opportunities to stay current on best practices in community health work, ensuring the delivery of quality services to clients.
- Worked directly with patient treatment teams and participated in care coordination procedures.
- Managed enrollment, transportation, and paperwork for individuals to take advantage of community resources.
- Increased awareness of available resources by organizing and participating in community health fairs and events.
- Provided ongoing support for clients managing chronic conditions, contributing to better self-management and reduced complications.
Customer Care Professional
Centene Corp
Charlotte, North Carolina
10.2019 - 02.2020
- Maximized satisfaction by anticipating needs and consistently offering expert support.
- Recaptured customer loyalty with expertise in de-escalating conflicts and building personalized solutions.
- Handled customers' advanced needs with properly escalated calls and scheduled service appointments.
- Answered customer questions about policies and procedures with friendly and knowledgeable approach.
- Protected customer and company information with strict use of established security procedures.
- Met inbound customer needs while maintaining strict performance targets.
- Completed inquiries and followed up with customers to share findings and offer solutions.
- Resolved customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills.
Service Agent I
American Red Cross
Charlotte, North Carolina
06.2019 - 10.2019
- Improved quality of service by recommending process enhancements and new service offerings.
- Satisfied customers with expert support before, during, and after service appointments.
Prior Authorization Specialist
Xerox Corporation
Henderson, NC
08.2011 - 01.2016
- Deliver added value to client relationships.
- Identified, researched and resolved billing variances to maintain system accuracy and currency.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed insurance coverage for patients to determine which party was liable for payment.
- Verified important patient information such as insurance ID, demographics and medication lists for entry into patient management system.
- Routinely collaborated with department managers to correct problems and improve services.
Education
Bachelor - Healthcare Administration
University of Phoenix
Phoenix, Arizona09.2021
Associate of Applied Science - Medical Assistance
Kaplan University
Davenport, IA11.2010
High School Diploma - undefined
Northern Vance High School
Henderson, NC06.1992
Skills
- Microsoft Word
- Customer relations
- Written communication
- Google Drive
- Time management
- Task prioritization
- Case management
- Documentation
- Patient education
- Organizational skills
- Patient advocacy
- Medical terminology understanding
- Documentation proficiency
- Multidisciplinary team collaboration
- Healthcare operations
- Goal setting
- Policy adherence
- Process improvements
- Progress monitoring
- Insurance practices
- Resource allocation
Timeline
Care Coordinator
Centene
09.2021 - Current
Community Health Worker
Bright Health
09.2020 - 03.2021
Customer Care Professional
Centene Corp
10.2019 - 02.2020
Service Agent I
American Red Cross
06.2019 - 10.2019
Prior Authorization Specialist
Xerox Corporation
08.2011 - 01.2016
Associate of Applied Science - Medical Assistance
Kaplan University
High School Diploma - undefined
Northern Vance High School
Bachelor - Healthcare Administration
University of Phoenix