KELLY ROMRELL
Idaho Falls,ID
Summary
Strategic healthcare operations leader with expertise in payment integrity, claims administration, utilization management, and clinical quality. Proven ability to lead large-scale teams, drive data-driven decisions, and execute complex initiatives across matrixed environments. Skilled in cross-functional collaboration, presenting technical insights to senior leaders, and optimizing processes to strengthen compliance, reduce financial risk, and improve outcomes. Forward-thinking operator who leverages technology and emerging AI tools to enhance performance, align talent, and deliver measurable business results.
Overview
26
26
years of professional experience
Work History
Associate Director, Claims Administration & Payment Integrity
Humana
09.2024 - Current
- Led enterprise payment integrity strategy across six inpatient and outpatient programs, enhancing provider payment accuracy and minimizing overpayments.
- Direct claims operations analytics and regulatory alignment to ensure correct claims payments and reduce financial risk.
- Drive corrective actions through trend analysis, anomaly detection, and performance reporting, improving audit accuracy and operational efficiency.
- Collaborate with clinical, operational, contracting, IT, and technology teams to modernize workflows and implement improvements that enhance payment accuracy.
- Ensured compliance with CMS regulations, coding standards, and payer policies to support accurate reimbursement and mitigate fraud exposure.
- Develop high-performing teams comprising clinicians and coders, fostering collaboration and expertise.
Utilization Management Manager
Humana
04.2019 - 09.2024
- Conducted performance audits to ensure CMS compliance and strengthen regulatory alignment.
- Implemented data-driven process improvements that enhanced operational efficiency and reduced errors.
- Strengthened cross-department workflows to improve coordination among clinical, operational, and technical teams.
- Guided teams through major initiatives, driving execution and ensuring successful adoption of new processes.
Revenue Integrity Clinical Team Lead
Parallon Business Performance Group
01.2017 - 04.2019
- Identified coding and charging discrepancies, enhancing accuracy and minimizing financial leakage.
- Delivered targeted education to clinicians and operational teams, improving documentation accuracy and coding quality.
- Analyzed performance data to monitor productivity, driving continuous improvement and operational accountability.
- Led teams through organizational changes, ensuring engagement and successful adoption of new processes.
Quality Consultant
Hill Country Memorial Hospital
07.2015 - 01.2017
- Directed joint commission preparedness, ensuring organizational readiness and regulatory compliance for sustained accreditation.
- Facilitated training sessions to promote evidence-based practices, enhancing clinical quality and adherence to best standards.
- Led root cause analyses and safety committee meetings to identify systemic issues and implement corrective actions.
- Developed comprehensive quality reports detailing findings, trends, and recommended solutions for leadership decision-making.
Quality Consultant
Logan Regional Hospital
01.2013 - 06.2015
- Strengthened review accuracy and documentation quality to reduce medical necessity adjustments and mitigate reimbursement risks.
- Implemented concurrent review of CMS national core measures, enhancing compliance and care quality across clinical teams.
- Delivered targeted education to improve documentation and regulatory compliance, boosting coding accuracy and audit readiness.
Clinical Charge Audit Analyst Revenue Integrity
Logan Regional Hospital
01.2011 - 01.2013
- Collaborated with multiple departments to ensure documentation met policies and regulatory standards.
- Identified risks in business activities by evaluating internal control systems, enhancing compliance.
- Served as liaison for cardiovascular services, respiratory care, sleep lab, ICU, ED, trauma, and surgical services, facilitating consistent communication.
- Led monthly audits to pinpoint risk areas in administrative and clinical processes, improving compliance.
- Implemented over 50 corrective actions within one year, partnering with leaders to address documentation issues.
RN Staff Nurse
Logan Regional Hospital
08.2000 - 01.2011
- Demonstrated strong patient assessment skills to identify clinical needs and determine interventions.
- Managed time effectively, prioritizing care to meet urgent patient needs in fast-paced environments.
- Collaborated with multidisciplinary teams to coordinate comprehensive patient-centered care plans.
- Applied critical thinking in high-acuity situations, making sound clinical decisions and escalating care when necessary.
- Provided care across multiple specialty areas, adapting swiftly to diverse patient populations and workflows.
Education
Master of Science (M.S.) - Nursing
Western Governors University
Utah01-2023
Bachelor of Science (B.S.) - Nursing
Western Governors University
Utah01-2011
Associate in Science (A.S.) - Nursing
Ricks College
Idaho01-2000
Skills
- Analytical decision making
- Reimbursement process knowledge
- Collaborative leadership
- Process optimization techniques
- Regulatory compliance
- Program design and policy implementation
- Oversight of payment integrity processes
- Fraud risk management
- Oversight of vendor relationships
- Technology-driven process optimization
- Implementation of strategic initiatives
- Coaching and mentoring
- Strategic execution planning
Certification
- Licensed Registered Nurse
Timeline
Associate Director, Claims Administration & Payment Integrity
Humana
09.2024 - Current
Utilization Management Manager
Humana
04.2019 - 09.2024
Revenue Integrity Clinical Team Lead
Parallon Business Performance Group
01.2017 - 04.2019
Quality Consultant
Hill Country Memorial Hospital
07.2015 - 01.2017
Quality Consultant
Logan Regional Hospital
01.2013 - 06.2015
Clinical Charge Audit Analyst Revenue Integrity
Logan Regional Hospital
01.2011 - 01.2013
RN Staff Nurse
Logan Regional Hospital
08.2000 - 01.2011
Bachelor of Science (B.S.) - Nursing
Western Governors University
Associate in Science (A.S.) - Nursing
Ricks College
Master of Science (M.S.) - Nursing
Western Governors University