Nicole Galbreath
Goldsboro,NC
Summary
Dynamic and detail-oriented professional seeking a challenging position as an Income Maintenance Caseworker, leveraging strong analytical skills and a commitment to precision in delivering essential services. Proven ability to navigate complex case management processes while ensuring compliance with regulations and policies. Dedicated to enhancing client outcomes through effective communication and problem-solving. A passion for helping individuals access vital resources drives a commitment to excellence in service delivery.
Overview
21
21
years of professional experience
Work History
Income Maintenance Caseworker II – Outpost (Wilson County Health Dept.)
Wilson County Department of Social Services
Wilson, NC
08.2022 - Current
- Conduct client interviews to assess eligibility for Family & Children's Medicaid, Adult Medicaid, Emergency, and Presumptive programs
- Process applications, recertification, auto newborn, and presumptive cases for Family and Children's Medicaid per NC Medicaid policy
- Maintain accurate case documentation in compliance with federal and state regulations.
- Collaborate with clinics, providers, and hospitals to coordinate health coverage.
- Provide clear program information and timely communication to clients
- Reduce errors in eligibility decisions through meticulous attention to detail and thorough documentation.
- Helped clients gather necessary documentation for application processes.
- Managed high caseloads, prioritized tasks, and utilized time-management skills to consistently meet deadlines.
- Conducted thorough assessments to identify client needs and developed tailored interventions for optimal care.
- Previously served as team lead for the call center, handled second-party calls, and managed call escalations.
- Process FNS applications and recertification's, Adult Medicaid applications, and Long-Term Care cases.
- Provide support to colleagues, shared expertise on complex cases, and assisted in training new team members.
Patient Care Coordinator Medicaid
UNC Wayne Memorial Hospital
Goldsboro, NC
05.2020 - 07.2022
- Managed sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.
- Coordinated with insurance companies for accurate billing and claim processing, reducing errors and financial discrepancies.
- Delivered excellent patient experiences and direct care.
- Enhanced patient satisfaction by efficiently scheduling appointments and managing patient flow.
Patient Counselor, Business Office
Vidant Health
Greenville, NC
03.2018 - 05.2020
- Received internal calls and assisted walk-in customers by resolving questions, inquiries, and complaints about billing matters in a timely manner.
- Arranged suitable payment plans and interviewed patients to determine eligibility for financial assistance programs for hospital and physician bills.
- Verified and added insurance coverage to claims, reviewed incoming mail, and documented all accounts.
Patient Advocate / Prior Authorization Representative
Duke University Medical Center
Durham, NC
01.2017 - 03.2018
- Served as a specialty pharmacy patient advocate for Hepatitis C patients.
- Conducted qualitative interviews with clients and providers and connected patients to medication through pharmaceutical assistance programs (PAPs).
- Provided follow-up services to re-engage clients in care and monitored treatment adherence outside the provider setting.
- Entered qualitative assessment results and patient data into databases to monitor treatment progress.
- Provided patient education and tracked HCV quality indicators.
- Researched and verified insurance information, submitted and followed up on prior authorizations, and worked appeals.
- Entered prescriptions, printed labels, filled new and refill orders, handled adjudications, and arranged medication delivery or pickup.
Pharmacy Technician / Prior Authorization Representative
CVS Specialty Pharmacy
Raleigh, NC
09.2013 - 01.2017
- Handled inbound and outbound calls for specialty medications for long-term care facilities and individual patients.
- Entered prescriptions, printed labels, filled new and refill orders, and handled prior authorization issues and adjudications.
- Processed orders and refills received by fax and entered new member information, insurance details, and medical history.
Department Manager, Pharmacy
Wal-Mart
Goldsboro, NC
09.2005 - 09.2013
- Provided customer service, managed department schedules, maintained inventory, and stocked merchandise.
- Reviewed pharmacy sales, expense, and productivity figures and adjusted plans as necessary.
- Monitored department profit and loss, cleanliness, regulatory and legal requirements, third-party insurance matters, and audits.
- Approved and submitted orders for equipment, merchandise, and supplies.
Teacher Assistant
Dillard Academy Charter School
Goldsboro, NC
08.2005 - 12.2005
- Assisted teachers with classroom instruction and continued lessons when the teacher was unavailable.
- Helped organize extracurricular activities and encouraged student participation.
- Provided students with additional academic support and communicated with parents during parent-teacher meetings.
- Designed lessons and supported completion of the curriculum.
Education
Pharmacy Technician Certificate -
Wayne Community College
Goldsboro, NC01-2005
Skills
- Eligibility assessment
- Application processing
- Case documentation
- Health coverage knowledge
- Social services operations
- HIPAA compliance
- Documentation skills
- Data entry
- Client interview techniques
- Client engagement
- Communication skills
- Interpersonal communication
- Customer service
- Policy analysis
Timeline
Income Maintenance Caseworker II – Outpost (Wilson County Health Dept.)
Wilson County Department of Social Services
08.2022 - Current
Patient Care Coordinator Medicaid
UNC Wayne Memorial Hospital
05.2020 - 07.2022
Patient Counselor, Business Office
Vidant Health
03.2018 - 05.2020
Patient Advocate / Prior Authorization Representative
Duke University Medical Center
01.2017 - 03.2018
Pharmacy Technician / Prior Authorization Representative
CVS Specialty Pharmacy
09.2013 - 01.2017
Department Manager, Pharmacy
Wal-Mart
09.2005 - 09.2013
Teacher Assistant
Dillard Academy Charter School
08.2005 - 12.2005
Pharmacy Technician Certificate -
Wayne Community College