Kendra Hinton
Community Health Educator
Burlington,NC
Summary
Quality Assurance Auditor adept at developing and maintaining strong Medicaid compliance programs. Hardworking and organized professional with in-depth understanding of evaluation processes and audit procedures. Pursuing new professional challenges with an expanding operation. Motivated Client Success Manager with experience successfully managing and monitoring eligibility information for members and groups. Highly skilled at facilitating program approval or denial through qualifications assessment, fact checking and record keeping. Confident and committed to promoting positive customer outcomes through dynamic communication and exemplary engagement skills.
Overview
8
8
years of professional experience
Work History
Community Health Educator, AmeriHealth Caritas, Telecommute
06.2019 - Current
- Presents and explains program benefits to potential members
- Develops, implements and manages community outreach opportunities and activities ensuring that activities is staffed and supplied adequately
- Works with various community agencies to coordinate meetings and activities that will allow company to establish relationship within assigned service areas
- Develop, build and maintain strong customer relationships /
- Supports member retention and assists auto enrollees with the selection of primary care physicians, explains program benefits and assists in follow-up to Member
- Services for members with concerns
- Provide oversight and facilitate coordination of current and new quality programs
- Conducts seminars to support and the understanding of managed care policies and procedures
- Establishes and maintains professional relationships at scheduled sites and at community events
- Manage, maintain and grow client relationships with state agency and/or local education agency (school district) stakeholders
- Adheres to flexible scheduling to include weekends, evenings and special events
- Seeks out and identifies opportunities within the community for site setup and event participation
- Coordinate with DSS, Ombudsman and Enrollment Broker
Operations Quality Auditor
AmeriHealth Caritas, Telecommute
05.2020 - 12.2020
- Performs reviews of Member Appeal episodes to ensure all contractual requirements have been met and all appeal components have been completed accurately
- Plans and executes independent, objective internal audits designed to test and confirm compliance with applicable State and Federal laws
- Analyzes and understands regulatory requirements and applies identified requirements to business operations when developing and conducting compliance audits
- Support the pay-for-performance programs, including data entry, tracking, organizing, and researching informationCoordinates and performs audit procedures; creates work products such as audit analysis; prepares audit plan and final report summary
- Monitors the progress, up to the remediation, of all deficiencies once identified
- Supports the fulfillment of internal/external audits as required in facets
- Maintains files on individual appeals and grievances
- Performs other job-related duties and projects as assigned
- Entered denials and request for appeal into information systems and prepares documentation for further review
- Determines appropriate language for letters and prepares responses to appeals and grievances
- Conduct contract analysis
Community Outreach Representative
UnitedHealthcare- Telecommute
10.2017 - 04.2019
- Educate, inform and collaborate with key partners across North Carolina, marketing information about Dual Special Needs Plan (Medicare and Medicaid)
- Acts as service representative and resource for assigned projects
- Developed and maintained positive provider relationships
- Tracks and conducts provider refresher training
- Establish relationships and partnerships with providers and community-based organizations such as professional and ancillary to promote Dual Special Needs Plan
- Assists in setting up, obtaining materials and supplies for exhibits and meetings with community and providers
- Assists in collecting, tracking and organizing educational material on community networks and advocacy groups
- Supports health education activities programs as they relate to the target dual population
- Manages and tracks leads and data pertaining to dual events and outreach
- Assists Sales leadership in preparing documents for plan reporting and provides analysis on implications of lead generation and other data
Program Manager, Enrollment
Advance Community Health
Raleigh, NC
08.2016 - 08.2017
- Serve as the point of contact for individuals and/or families contacted during outreach activities regarding public health and marketplace insurance enrollment
- Compile and prepare reports for the Outreach and Enrollment program including but not limited to local, state and federal funder requirements
- Create patient surveys
- Perform research-based analysis – review and summarize articles from nationally recognized journals on select health care topics such as value-based purchasing, procurement, behavioral health and long-term services and supports
- Provide health education to patients and community residents
- Assist with building, viewing, and quality checking all reporting
- Conduct presentations on health topics
- Conduct outreach, intake and assessment for clients needing health insurance
- Oversee/coordinates the submission of local, state and federal grants
- Participates in the development/expansion of programs and or services that supports the development and growth of the Outreach and Enrollment program
- Coordinates and participates in outreach efforts/activities for the Outreach and Enrollment program
- Assures, monitors and measures outcomes and deliverables for the Outreach and Enrollment program
- Schedule appointments for consumers seeking assistance with health insurance
- Attend community events, meetings and workshops
- Create and facilitate training for frontline staff
- Perform administrative duties such as data entry and filing
- Case Management, provide and document ongoing case management
Lead of Health
Education and Outreach, Advance Community Health
Raleigh, NC
10.2014 - 07.2016
- Provided comprehensive and culturally sensitive information about public health programs
- Conducted outreach and referral services for clients in need of public health or social services assistance
- Provided timely assessment and processing of health insurance marketplace applications; track eligibility, approval and utilization
- Maintained and report accurate weekly and monthly reports
- Assisted clients with enrollment in various federal and state medical coverage programs in person and via telephone
- Assisted clients through a variety of application processes -such as applying for Food and
- Nutrition Services, Medicaid, NC Health Choice, Medicare SSI, SSDI and the Health Insurance
- Marketplace to obtain social services, hospital charity care, housing, and vocational support among other programs
- Provided technical support and assistance in various outreach locations
- Assessed client needs and make appropriate referrals when necessary
- Conducted presentations on the Affordable Care Act
- Promoted wellness by providing culturally appropriate health information to clients
- Coordinated site visits for temporary staff.
Administrative Assistant
Southlight Healthcare
Raleigh, NC
09.2014 - 03.2015
- Provided check in services for all scheduled client appointments
- Answered phones and schedule appointments as needed
- Collected and reconcile cash/credit card co-pays and services fees from client upon registration
- Provided general administrative support for the program including filing, typing, copying, data entry and faxing
Education
Google Project Management Certificate - undefined
Project Management Institute
Bachelor of Science - Public Health Education
North Carolina Central University (NCCU)
Skills
- Rejected Materials Disposal
- Quality Assurance and Control
- Document Quality
- Financial Reconciliations
- Effective Communication Skills
- Document Management System Software
- Microsoft Word
- Customer Satisfaction
Timeline
Operations Quality Auditor
AmeriHealth Caritas, Telecommute
05.2020 - 12.2020
Community Health Educator, AmeriHealth Caritas, Telecommute
06.2019 - Current
Community Outreach Representative
UnitedHealthcare- Telecommute
10.2017 - 04.2019
Program Manager, Enrollment
Advance Community Health
08.2016 - 08.2017
Lead of Health
Education and Outreach, Advance Community Health
10.2014 - 07.2016
Administrative Assistant
Southlight Healthcare
09.2014 - 03.2015
Google Project Management Certificate - undefined
Project Management Institute
Bachelor of Science - Public Health Education
North Carolina Central University (NCCU)
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