Ja'Meria Hinton

Out of State Medicaid Provider Enrollment Specialist - Optimum Outcomes

Raleigh, NC

acfenp@r.postjobfree.com - 919-***-****

WORK EXPERIENCE

(NC Medicaid) Credentialing/Data Entry/ Written Correspondence/Claims Processing/

Call Center Operator

CSC - Raleigh, NC - June 2013 to December 2013

Responsibilities

* Processing applications for medical providers using their NPI information so that they are able to submit

claims for patients that receive North Carolina Medicaid

* ReviewingMC Medicaid provider applications for completeness as determined by provider type and

enrollment criteria in a timely manner

* Process file maintenance update from written correspondence in a timely manner

* Contacting and Receiving calls from providers wanting to know the status of their application

*Collects and organize data from mainframe files, data warehouse reports, vendor extracts, departmental

spreadsheets and databases, and internet/intranet sites for easy use by internal business and analytical clients

*Answers incoming phone calls on behalf of client; provides accurate and appropriate information to callers.

*Performs clerical or administrative duties as assigned

*Interpret data, analyze results using statistical techniques and provide ongoing reports.

*Acquire data from primary or secondary data sources and maintain databases/data systems

*Answer telephones and responds to NC Medicaid Providers questions and/or forwards call to appropriate

personnel.

*Record call on account history record with results of the inquiry; initiates required confirmation without direct

supervision. Researches NC Medicaid Providers inquiries and responds to appropriate parties in a timely

manner.

* Process calls in a manner that ensures service level agreements (SLAs) are met or exceeded. Records calls,

processes requests and updates account history with results of inquiry to include proper documentation.

* Interface with team members, management, and customers in reference to customer service issues

* Review and recommend modifications to procedures and workflow as necessary to ensure efficient and

effective processing of transactions

Skills Used

Customer Service, Processing, and Data Entry

Out of State Medicaid Provider Enrollment Specialist

Optimum Outcomes - Raleigh, NC - March 2012 to May 2013

Medical Billing (Keying and processing medical claims)

*Specialized in credentialing initial and re-applications for healthcare professionals such as M.D.'s, D.O.'s and

Allied Health Professionals. Research and reviewing applications providing a range of technical, administrative,

clerical and investigative support work verifying background credentials, education, internships, residences,

employment history, licensure, professional references, hospital affiliations, liability claims, criminal history and

social security validation.

*Performing on-line queries from a variety of resources, such as the National Practitioner Data Bank, American

Medical Association, Drug Enforcement Administration, American Board of Medical Specialties and Office of

the Inspector General

*Regularly gathering data and entering information to the database.Maintaining strict level of confidentiality

on all matters. Keeping files secure and organized for auditing. Communicating clearly and professionally

generating letters and emails to hospital affiliations and other agencies to obtain required information and

verifications. Verbally communicating daily with doctors, medical staff and healthcare coordinators and

applying my skills in various situations.

*Providing staff support ensuring that files are being processed in a timely manner and reports ready as

requested on a periodic basis. Monitoring and tracking progress and status. Prioritizing daily, multi tasking

when projects cross over meeting all deadlines. Establishing contacts and increasing potential resources.

*Excellent filing organization and follow up skills, phone and email tracking. Responding to any expedited

requests and inquiries from other agencies. Receiving, screening mail and emails. Self motivated and

responsible in completing required tasks as necessary. The ability to effectively work well with others in a

team environment. Coordinating all processes investigating, verifying and finding solutions to determine the

best course of action.

*Maintaining contact with designated contact person to obtain application signatures, and collect all required

attachments to include with completed application.

*Communicate & advise hospital CEO or designated contact person of the needed paperwork necessary to

begin the application process for new physicians, including any necessary research to gather all details to

appropriately enroll provider.

*Creating the online web portal for each of our facilities in all 50 states and creating/maintaining a spreadsheet

with all user names and password for the facilities

Owner/ Operator

Kidzz Kingdom Family Childcare - Raleigh, NC - February 2010 to February 2012

Completed daily lesson plans for children ages 0-12

*Weekly field trips with children

*Prepared breakfast, lunch, dinner, and snacks

*Cleaned childcare area as well as equipment

*Provided transportation to and from for the children

*Kept all documents current and up to date

*Collected payments from parents on a weekly basis

Credentialing Assistant/ Data Analyst

Data Staff - Raleigh, NC - April 2009 to February 2010

Processing applications for medical providers using their NPI information so that they are able to submit claims

for patients that receive North Carolina Medicaid

*Reviewing provider applications for completeness as determined by provider type and enrollment criteria in

a timely manner

*Process file maintenance update from written correspondence in a timely manner

*Contacting and Receiving calls from providers wanting to know the status of their application

*Processing claims/escalations

*Handle written correspondence

*Worked with DMA and EDS

*Document Management

*Data Entry

*Filing

*Faxing

*Research

*Special Projects

*Completing Spreadsheets

*Word, Excel, Power Point, and Lotus Note

Habilitation Technician

Advance Health Resources - Raleigh, NC - March 2008 to June 2009

Working with clients with disabilities on goals that were set by the state

* Direct In home care/ group home setting

* Completing proper paperwork that stated the goals that were worked on with the client

*Weekly reporting to my supervisor the progress my client was making

* Daily supervision

*Document Management

*Data Entry

*Filing

*Faxing

*Research

*Special Projects

*Completing Spreadsheets

*Word, Excel, Power Point, and Lotus Notes

Foster Care Specialist

Caring Family Network - Durham, NC - June 2007 to December 2007

Responsible for assisting with the marketing of the Foster Care Program and recruiting high quality Foster

parents *Tracking, monitoring, and processing foster parent license applications and renewal applications.

*Communication with foster families and program staff.

*Assisting in obtaining basic information on children referred to CFN foster care when intake coordinator is

not available

*Ensure foster parent homes and files are maintained and in compliance with State, Federal, COA rules and

regulations.

*Assisting with foster parent interviews, home studies and trainings in order to complete a thorough assessment

of the foster parent's strengths and limitations.

*Initiating Privileging and Credentialing for foster parents.

*Monitoring the completion of the annual Foster Parent Evaluations.

*Coordinating or conducting exit interviews with parents who terminate their contract with the agency

*Coordinating with programs to ensure that Pre-Service Orientation meetings are completed in order to assist

foster parents with agency and position orientation.

*Data Entry

*Customer Service

*Word, Excel, Power Point, and Lotus Notes

Customer Service Representative

Today's Staffing - Raleigh, NC - January 2007 to June 2007

NPI Program)

*Data Entry

*Filing

*Faxing

*Calling Medical Providers requesting information to Update NPI Accounts

*Receiving calls from Medical Providers wanting to know the status of their updated NPI information

* Provided Medicaid NPI eligibility verification to medical providers

*Check and Recheck applications for provider errors and once done issued National Provider Identification

and Taxonomy numbers

*Worked with DMA and EDS

*Medical Terminology

*Customer Service (high volume call center)

*Word, Excel, Power Point, and Lotus Notes

*Special Projects

*Investigating client accounts

Direct Marketing Rep (Verification)

The Planning Group - Wilson, NC - January 2006 to January 2007

Researching potential Clients to make sure that we have accurate information

*Placing calls to different companies to find out if they offer health benefits

*Mailing out information about the company to potential clients

*Data Entry/Basic Office

*Customer Service

*Document Management

*Filing

*Faxing

*Special Projects

*Completing Spreadsheets

*Word, Excel, Power Point, and Lotus Notes

Customer Service Representative/ Call Center

West Corporation - Rocky Mount, NC - February 2005 to January 2006

Accepting incoming calls regarding billing and service issues

*Data Entry

*Switchboard

*Researching accounts for any problems/ Trouble shooting

*Microsoft Word, Excel

*Customer Service (high volume call center)

*Document Management

*Research

*Special Projects

*Completing Spreadsheets

*Word, Excel, Power Point, and Lotus Notes

EDUCATION

Associate in Human Service

NASH COMMUNITY COLLEGE - Rocky Mount, NC

2013 to 2015

Customer Service Certification

Nash Community College

June 2003 to September 2005

Certificate in Medical Transcription/ Terminology

Wilson Technical Community College

December 2004

High School Diploma

Rocky Mount Senior High School

September 2000

SKILLS

Medical Research, Program Creation, Team Lead, Customer Service, Claims Processing, Enrollment,

Credentialing

Contact this candidate