Work Preference
Summary
Overview
Work History
Education
Skills
Timeline
Generic
Open To Work

Kimberly Y. Smith

Fayetteville,NC

Work Preference

Job Search Status

Open to work
Desired start date: 2 weeks notice

Desired Job Title

Office AssociateProvider Enrollment AnalystClaims Representative

Work Type

Part TimeFull TimeContract Work

Location Preference

RemoteOn-SiteHybrid
Location: Fayetteville, NC, USRaleigh, NCDurham, NC
Open to relocation: Yes

Salary Range

$45000/yr - $200000/yr

Important To Me

Work-life balanceFlexible work hoursHealthcare benefitsWork from home optionPaid time off

Summary

Motivated individual. Recognized for attention to detail and customer satisfaction. Resourceful and well-organized with excellent project management, customer service, claims and team building skills. Dedicated and hardworking with internal drive to deliver.

Experienced with improving customer satisfaction through effective communication and problem resolution. Utilizes strong interpersonal skills to build rapport and ensure positive customer interactions. Track record of adapting to changing customer needs and enhancing service processes.

Overview

21
21
years of professional experience

Work History

Substitute Teacher

ESS
04.2025 - Current
  • Implement provided lesson plans to ensure curriculum continuity and student progress.
  • Communicate effectively with students, parents and school staff to build rapport and contribute to a supportive educational community.
  • Adapted lesson plans to meet diverse student needs and learning styles.
  • Developed positive relationships with students, enhancing classroom morale and engagement.
  • Managed classroom resources efficiently, optimizing instructional time and materials usage.
  • Collaborated with teachers to communicate student progress and behavior issues.
  • Maintained classroom order, ensuring a safe and productive learning environment.

Independent Contractor

Self Employed Customer Service Associate
12.2022 - Current
  • Maintain customer satisfaction with forward-thinking strategies focused on first call resolution.
  • Handle high volume of calls promptly to avoid on-hold wait times.
  • Assisted customers with inquiries, providing accurate information and resolving issues efficiently.
  • Developed strong product knowledge to deliver exceptional service and enhance customer satisfaction.
  • Managed multiple tasks simultaneously while maintaining attention to detail in a fast-paced environment.
  • Utilized CRM software to track customer interactions and ensure timely follow-ups on inquiries.
  • Adapted quickly to new systems and procedures, ensuring seamless operations during transitions.

Results Associate

ResultsCX (WellCare NC)
12.2024 - 02.2025
  • Frequently provide first call resolution while handling Medicaid customer benefit inquiries, claim questions, hardship assistance and over the counter (OTC) orders.
  • Offer correct and current advice with the use of internal knowledge base articles.
  • Anticipated needs and frequently resolved problems to maintain customer satisfaction.
  • Manage over 40 customer calls daily and efficiently in a fast-paced call center environment.
  • Supported daily operational tasks to enhance team efficiency and service delivery.
  • Executed routine administrative functions, ensuring accuracy in documentation and reporting.
  • Developed strong rapport with customers and created positive impression of business.

Office Associate

Supreme Health Systems
12.2022 - 07.2023
  • Coded, submitted and managed claims.
  • Researched, worked, and resolved claim denials and rejections.
  • Assumed ownership over all aspects of the billing cycle, including Charges, Payments, and AR metrics and performance.
  • Kept on task to meet all required deadlines and timeframes for customer and company needs.
  • Took on additional management roles and duties as needed.
  • Supported billing processes by verifying insurance information and processing patient payments efficiently.
  • Handled sensitive information with discretion, ensuring confidentiality and maintaining trust within the office.
  • Volunteered to help with special projects of varying degrees of complexity.

Independent Consultant

Advanced Tax Solutions, LLC
11.2019 - 05.2020
  • Performed CRM testing and change implementation, as well as assisted customers with tax software related matters, billing, setup and technical support through live chat and online virtual support.
  • Streamlined workflow processes, enhancing efficiency in tax preparation and filing procedures.
  • Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions.

Provider Enrollment Analyst

Palmetto GBA
11.2020 - 06.2022
  • Responsible for reviewing, researching, analyzing and processing provider enrollment applications.
  • Ensured provider file integrity and their suppliers were in compliance with established Medicare & HIPPA standards and guidelines.
  • Analyzed provider enrollment data to ensure compliance and accuracy in submissions.
  • Assisted with onboarding processes for new healthcare providers, streamlining documentation.
  • Coordinated communication between providers and internal teams to resolve enrollment issues.
  • Reviewed applications for completeness, identifying discrepancies and facilitating corrections.
  • Proactively identified potential risks associated with specific enrollments, taking appropriate action to mitigate them before issues arose.
  • Maintained strict confidentiality standards, ensuring sensitive provider data was handled with the utmost care and discretion.

Program Manager Associate

Blue Cross Blue Shield of North Carolina
09.2015 - 03.2018
  • Managed departmental and enterprise initiatives.
  • Provided full end to end program management with moderately complex programs by identifying, analyzing, developing, implementing and managing change.
  • Program lead for the Provider/Member Onsite Program within 6 major hospital systems.
  • Facilitated between hospitals, members/patients and BCBSNC to ensure better provider/member relations through clear communication, prompt claims payment and resolution.
  • Lead for Employee Satisfaction initiative within the Customer Service Department.
  • Developed and implemented process improvements to enhance program efficiency and member satisfaction.
  • Managed stakeholder communications to align project goals with organizational objectives.
  • Established strong relationships with key stakeholders, ensuring support for program initiatives.

Project/Program Coordinator

Blue Cross Blue Shield of North Carolina
06.2012 - 09.2015
  • Supported leadership and project/program participants in the development, administration, implementation and closure of projects/programs.
  • Assisted with Provider/Member Onsite models setup.
  • Met with relevant internal & external leaders to discuss the program and requirements.
  • Facilitated the implementation of 2 onsite models.
  • Coordinated program schedules and logistics to enhance operational efficiency.
  • Assisted in developing training materials to support staff onboarding and development.

Business Analyst Associate

Blue Cross Blue Shield of North Carolina
10.2011 - 06.2012
  • Provided assistance to relevant leaders in the administration and coordination of projects and programs by the use of information gathering.
  • Kept customer service knowledge articles up to date.
  • Analyzed business processes to identify areas for improvement and efficiency gains.
  • Collaborated with stakeholders to gather requirements and translate them into functional specifications.

Operations Specialist

Blue Cross Blue Shield of North Carolina
07.2008 - 10.2011
  • Subject Matter expert for the Customer Service Department.
  • Assisted CSRs with proper call handling and crafting of sensitive information.
  • Handled 1st level escalations and claims approvals up to $50,000.
  • Educated callers on the appeals process when there calls escalated over claim denials due to medical necessity.
  • Resolved and responded to 1st level provider/member claims disputes per medical policy.
  • Provided one-on-one training, auditing, root cause analysis of calls and the handling of correspondence.
  • Streamlined operational workflows to enhance efficiency and reduce processing times.
  • Coordinated cross-departmental communication to align project goals and deliverables.
  • Developed training materials for onboarding new staff, improving knowledge retention.

Customer Service Representative(CSR)

Blue Cross Blue Shield of North Carolina
09.2004 - 07.2008
  • Utilized knowledge manuals to stay up to date on eligibility, benefits, claims, appeals and billing inquiries.
  • Documented customer interactions and feedback to improve service processes.
  • Developed training materials to streamline onboarding processes for new representatives.
  • Used conflict resolution skills to de-escalate highly emotional callers.
  • Followed-up with internal and external customers by outbound calls and correspondence.
  • Extremely knowledgeable on problem-solving and how to address my callers with empathy and respect.
  • Delivered exceptional customer service through effective communication and problem resolution.
  • Assisted customers with inquiries, ensuring timely and accurate responses to their needs.

Education

Practitioner Program in Project Management Certification -

University of Colorado Denver
08.2015

Certificate - undefined

Certified Professional Coder Boot Camp
06.2012

High School Diploma -

Westover Senior High
Fayetteville, NC

Skills

  • Project management
  • Time management
  • Positive and professional
  • Problem resolution
  • Medical terminology
  • Knowledge of FACETS and other computerized claims processing systems
  • Strong communication
  • Detail oriented
  • Calm under pressure
  • Call management
  • Claims dispute
  • Data entry

Timeline

Substitute Teacher

ESS
04.2025 - Current

Results Associate

ResultsCX (WellCare NC)
12.2024 - 02.2025

Office Associate

Supreme Health Systems
12.2022 - 07.2023

Independent Contractor

Self Employed Customer Service Associate
12.2022 - Current

Provider Enrollment Analyst

Palmetto GBA
11.2020 - 06.2022

Independent Consultant

Advanced Tax Solutions, LLC
11.2019 - 05.2020

Program Manager Associate

Blue Cross Blue Shield of North Carolina
09.2015 - 03.2018

Project/Program Coordinator

Blue Cross Blue Shield of North Carolina
06.2012 - 09.2015

Business Analyst Associate

Blue Cross Blue Shield of North Carolina
10.2011 - 06.2012

Operations Specialist

Blue Cross Blue Shield of North Carolina
07.2008 - 10.2011

Customer Service Representative(CSR)

Blue Cross Blue Shield of North Carolina
09.2004 - 07.2008

Certificate - undefined

Certified Professional Coder Boot Camp

Practitioner Program in Project Management Certification -

University of Colorado Denver

High School Diploma -

Westover Senior High

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