Summary
Overview
Work History
Education
Skills
Timeline
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KIMBERLI STAMEY

MOUNT ULLA,NC

Summary

Over 15 years of experience in healthcare management and social services. Expert in HIPPA compliance, case management, and training & development, with a proven track record of maximizing medical benefits for patients. Adept at mentoring staff and enhancing organizational efficiency, seeking to leverage extensive expertise in a challenging new role.

Overview

26
26
years of professional experience

Work History

Sr. Eligibility Consultant

CVS/Aetna
, NC
10.2024 - Current
  • As an Enrollment Representative, I support multiple health plans. I verify enrollment statuses, makes changes to member/client records, and address a variety of enrollment questions or concerns. Maintenance of enrollment databases, coordinates the transfer of electronic eligibility data. Responds, researches, and resolves eligibility and/or billing-related issues involving member-specific information; works directly with clients, field marketing offices, and/or local claim operations to achieve positive service outcomes. Monitors daily status reports, assessing output for developing trends potentially impacting service levels. Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.

PATIENT CONTINUITY NEEDS ADVOCATE

ChenMed-Dedicated Senior Medical Center
Greensboro, NC
01.2023 - 12.2023
  • Facilitated patient care continuity, ensuring seamless transitions and improved patient outcomes
  • Coordinated with healthcare teams to address patient needs, enhancing satisfaction and retention
  • Analyzed patient data to identify gaps in care, implementing solutions for better health management
  • Supported patient advocacy initiatives, reducing readmission rates and fostering trust
  • Support Medicaid enrollment; collect demographic and financial data; initiate follow-up procedures

PATIENT ENGAGEMENT TRAINER II

Community Health Systems-Eligibility Screening Services
Franklin, TN
02.2016 - 08.2022
  • Trained and audited business office processes, optimizing Medicaid, Medicare, Social Security and SSI workflows among other social service programs
  • Recommended process improvements to leadership, achieving significant efficiency gains
  • Mentored staff on performance techniques, fostering professional growth and continuous learning
  • Assisted in hiring and interviewing, ensuring high-quality candidate selection
  • Provided critical temporary onsite coverage across U.S
  • Facilities, ensuring uninterrupted patient services and maintaining operational continuity

MEDICAID/SNAP CASEWORKER II

Union County Department of Social Services
Monroe, NC
01.1999 - 01.2006
  • Spearheaded process improvements in Medicaid and Medicare workflows, driving substantial efficiency gains and enhancing patient service delivery
  • Managed eligibility and ongoing caseloads for economic service programs, ensuring timely assistance
  • Supported Medicaid enrollment by collecting and verifying documentation, initiating follow-ups as needed
  • Assessed client needs and facilitated access to appropriate services, enhancing overall service delivery
  • Utilized Electronic Medical Records (EMR) for accurate patient data management and issue resolution

Education

BACHELOR OF SCIENCE - CRIMINAL JUSTICE

UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE
Charlotte, NC
01.1992

NC CLAIMS ADJUSTER TRAINING -

AdjusterPro
03.2024

CERTIFIED PHARMACOLOGY/PHARMACEUTICAL SALES REP -

NAPSRx

CERTIFIED AFFORDABLE CARE ACT COUSELOR -

08.2022

CERTIFIED DENTAL ASSISTANT I -

Lake Norman Dental Assisting School
03.2013

Skills

  • Account/Case Management
  • Training & Development
  • Microsoft/Google
  • Leadership & Mentoring
  • Critical Thinking
  • Customer Service
  • Interviewing
  • HIPPA Compliance

Timeline

Sr. Eligibility Consultant

CVS/Aetna
10.2024 - Current

PATIENT CONTINUITY NEEDS ADVOCATE

ChenMed-Dedicated Senior Medical Center
01.2023 - 12.2023

PATIENT ENGAGEMENT TRAINER II

Community Health Systems-Eligibility Screening Services
02.2016 - 08.2022

MEDICAID/SNAP CASEWORKER II

Union County Department of Social Services
01.1999 - 01.2006

BACHELOR OF SCIENCE - CRIMINAL JUSTICE

UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE

NC CLAIMS ADJUSTER TRAINING -

AdjusterPro

CERTIFIED PHARMACOLOGY/PHARMACEUTICAL SALES REP -

NAPSRx

CERTIFIED AFFORDABLE CARE ACT COUSELOR -

CERTIFIED DENTAL ASSISTANT I -

Lake Norman Dental Assisting School

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