Human Resources North Carolina

Kimberly Melton

919-***-**** Email: **********@*****.***

SUMMARY:

Professional performance driven with over 20 years of combined experience in leadership Administration, Operation Management, Sales and Human Resources. I am looking for a role where I can continue to expand my skills, take on new responsibilities, and make a meaningful contribution.

EDUCATION AND PROFESSIONAL DEVELOPMENT:

Masters, Business Administration Health Care, Strayer University North Carolina

Bachelor of Science, Business Administration, North Carolina Wesleyan College

American Medical Technologists, Registered Medical Assistant

National Association of Pharmaceutical Representatives, Certified National Pharmaceutical Representative

Pharmacy Technician Certification – 30146278-CPht-PTCB

PROFESSIONAL EXPERIENCE:

Duke Talent Care Center HR – HR Specialist – 5/24 – Present

Pay and Time & Attendance Iforms: Timecards, Gross Adjustments, Pay Exceptions, Biweekly Lump Sum, Supplement Card, Kiel Payment, Supplement Pay.

Time & Attendance: PTO Balance Adjustment, Time Card Access.

Hiring Iform: Hire and corrections, Staff Change, Terminations, Transfers, Cost Distribution, Personnel Data, Delimiting, Reorganization, Reclassifying, FMLA. Employment verification and loan forgiveness, SAP.

Duke Raleigh Cancer Center – Financial Care Counselor – 11/23-5/2024

Manage insurance authorizations for medications, treatments, MRI, CT authorizations.

Processes Initial applications for DUHS, ensuring compliance with regulatory requirements. Obtains verification from primary sources for all regulatory requirements and monitors all applications assigned to credentialing to provide updates to applicants and documents in the credentialing system in compliance with regulatory standards. Researches and maintains current and accurate data for all providers for the Health System within the Credentialing database. Verifies the legitimacy of practitioner information with the primary source of the credentials and in accordance with the accreditation regulatory standards, and state/federal laws for universities, licensing agencies, hospitals, and certification bodies.Maintains a complex credentialing database with up-to-date practitioner information, including medical license, drug enforcement administration (DEA) certificate professional liability insurance, board certifications, and renewal period expiration dates. Ensures data integrity within the Credentialing database for physician practice demographic information and ensures it is compliant with health plans, agencies, and other entities. Maintains confidentiality of all provider information within our credentialing database, as well as documentation gathered through the credentialing process.

Assist patients that have no insurance or out of network insurance and reduced benefit. Work with physicians and nurses that are in the field. Maintain schedules for nurses, CNA, LPN, and other specialties. Analyze relationships with patients, physicians, and staff.

Duke University Hospital – Durham, North Carolina – 12/ 2019-10/ 2022

Clinical Administration Specialist – Manage a designated caseload to coordinate and complete timely assessments, planning, implementation and evaluation of discharge plan and care transitions. The hospital step-down unit that has around 200 patients at any given time.

Monitor daily census and assignment to assure all patients needs are met for care in coordination/transition, discharge planning, consultations, and follow up appointments scheduled.

Maintain effective communication with health care team, homecare, Rehab Centers, and other hospitals. Maintain working knowledge of specific benefits and reimbursement guidelines, the discharge process and regulations. Obtain and receive records, labs, pathology, and images from outside hospitals on patients that are transferred to the hospital for further treatment. Maintain timely documentation of findings, discharge arrangements, FMLA paperwork for patients and family members. Prepare and maintain records as requested.

Developed and coordinated the position of Clinical Administration Specialist to help assist hospitalist and Students/Interns. Provide overall administrative direction and oversight for procedures, policies, and programs of the hospital. Maintain liaison with all levels of administration, physicians, students, and other staff as needed.

Direct the completion and prepare operational setting progress, trends and recommendations. Set up and attend meetings and conferences with fellow physicians and subordinates to ensure compliance, current changes and standards. Assure accountability for achievement of balanced scorecard targets are being achieved. Maintain the hospital readmission rate at a low level. In 2021 the Hospital had a readmission rate of 8%.

Medication reconciliation, prior authorization, medication refills, and medication changes

Maintain and develop positive working relationships with patients internal and external.

Multi-Specialty Medical Practice – Administrator/Operations Manager 09/ 2000-11/ 2019

Oncology, OBGYN, Family Practice, GI, Dermatology, Pediatrics, Endocrinology, Eye Care, Neurology, Allergy, Pulmonary, and Hospital Physicians and Student Interns

* Conduct and administer fiscal operations, accounting, planning budgets, and forecasting.

* Authorizing expenditures, establishing rates for services, and office procedures.

* Direct, supervise, and evaluate work activities for physicians, nursing, clerical, and others

* Promote an environment that fosters employee morale, teamwork, motivating and positive.

* Reinforcing culture, proactive approach, supporting values and Code of Ethics.

* Maintain communication with governing boards, physicians, clinical and clerical staff.

* Conduct recruiting, staffing, interviewing, onboarding, and training.

* Development and Implementation of policies and procedures, and Employee Handbook.

* Development of procedure instruction manuals for all procedure and protocols.

* Developed standardized Triage procedure manuals for standardization throughout practice.

* Ensure systems and processes for compliance with laws and regulation standards.

* Provide day-to-day guidance and oversight of active, current and future needs.

* Manage annual budges for recognition, local support, charities and community events.

* Monitor/Inventory vaccines for private and state programs.

* Monitor program volumes, RVUs, and contribution margins.

* Develop and maintain physician contracts, budges, bonus and incentives for each provider.

* Manage change in integrated health care deliver systems, restructuring, technological shifts.

* Consult with medical offices, community business and groups to discuss service problems.

* Respond to community needs, enhance public relations, coordinate activities, and programs.

* Manage company with a 3% growth during difficult times.

* Consistently alter plans/routines when situation requires and perform without stress.

* Participate in professional development activities and maintains professional affiliations.

* Provide leadership with conception, planning development and implementation

* Develop strategies to improve overall morale and engagement that measure progress

* Coordinate recruiting, staffing, interviewing, retention and onboarding, and training

* Monitor and provide continuous improvement plan for business processes to effective operations

* Manage front office operations to maximize patient experience, customer service and collections

* Establish and monitor production and facilities issues for the physicians and other staff

* Ensure systems and process for awareness and compliance with laws and regulation standards

* Participates in the planning and development of activities within the Community facilities

* Assures staff conforms to organizational policies and procedures and government regulations

* So much more that is needed to be done.

Walmart – 01/2022 – Present - Pharmacy Technician

OBGYN – Family Practice – 01/1990-09/2000

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