Summary
Overview
Work History
Education
Skills
Timeline
GAPS
Generic

Kimberly J Calloway

Elizabeth City

Summary

Dynamic administrative professional with over three years of experience in provider credentialing services, adept at navigating complex licensing procedures and ensuring regulatory compliance. Exceptional interpersonal skills and a proactive approach to problem-solving foster productive relationships with facilities, provider groups, and individual professionals. Renowned for strong organizational abilities and adaptability in fast-paced environments, consistently delivering timely approvals and driving team success. Committed to leveraging expertise in time management and collaboration to contribute to organizational growth and excellence.

Overview

22
22
years of professional experience

Work History

Licensing Specialist/ Credentialing Coordinator

Envision Healthcare
09.2021 - 07.2025
  • Assisted applicants in understanding the necessary documentation for licensing and communicated any additional regulatory requirements, demonstrating a strong attention to detail.
  • Utilized effective written and verbal communication skills to correspond with providers via email, fax, and phone, addressing inquiries and requesting items to meet licensing requirements.
  • Demonstrated proficiency in organizing and managing documentation by efficiently uploading forms and documents to provider folders, ensuring accurate record-keeping.
  • Displayed administrative competence by utilizing company resources, such as the company credit card, to pay for fees associated with the licensing process, showcasing financial responsibility.
  • Maintained up-to-date and comprehensive provider notes, enabling efficient tracking of licensing progress and facilitating timely communication with the licensing board.
  • Proactively identified pending items required by the licensing board and promptly communicated them to providers through well-crafted emails, ensuring compliance and timely completion.
  • Accomplished successful renewal of expiring licenses through meticulous preparation, submission, and follow-up of relevant documentation.
  • Provided exceptional customer service to applicants, addressing inquiries with accurate information and timely responses.
  • Served as primary point of contact for regulatory agencies, fostering positive relationships that facilitated smooth communications during inspections or audits.
  • Provided exceptional customer service and consistently performed quality services.

Credentialing Specialist

Sentara Healthcare
04.2020 - 04.2021
  • Ensure ongoing compliance with necessary credentials and licenses to operate within the designated field or specialization. Actively monitor upcoming renewal deadlines and collaborate with medical staff to provide timely guidance on the essential procedures for maintaining their credentials.
  • Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
  • Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
  • Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
  • Received and evaluated applications to look for missing and inaccurate information.
  • Reduced errors in credentialing files by conducting thorough reviews and consistently maintaining attention to detail.
  • Provided exceptional customer service, resolving complaints and answering queries promptly.

Credentialing Specialist

Optima Health
06.2018 - 03.2020
  • I have successfully managed and prioritized the documentation process for current and new providers' licenses and malpractice insurances. This involves efficiently handling insurance submissions received via email, fax, and mail. I have transitioned into a permanent role, where I consistently update and maintain daily spreadsheets to monitor the status of providers' credentials, ensuring timely renewals and identifying any expired credentials.
  • In this role, I regularly utilize various systems and websites such as Echo, CAQH, VA license website, Certificates, Excel, Word, Verify (Echo credentialing), and ABMS to accomplish tasks. Additionally, I handle incoming phone calls from providers and collaborate closely with other credentialing specialists to address inquiries and ensure accurate and up-to-date information. My primary objective is to ensure providers' compliance by proactively communicating via email regarding any outstanding requirements. Furthermore, I am responsible for data entry in the Echo system, diligently inputting and updating the information of new and existing providers for seamless credentialing processes.
  • Obtained NPI numbers for providers and facilities and updated existing profiles.
  • Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
  • Provided exceptional customer service, resolving complaints and answering queries promptly.

Claims Representative

Optima Health
07.2017 - 05.2018
  • Accountable for managing comprehensive customer service functions, encompassing member acquisition and retention.
  • Oversaw the processing of claims and facilitated effective communication with members, providers, and employers.
  • Took on the responsibility of handling all aspects of customer service related to member acquisition and retention including claim processing and interactions with members, providers, and employers. Calling providers about billing issues to correct medical claims. Correct claims so they can be paid
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Followed up with customers on unresolved issues.
  • Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.

Credentialing Specialist

Anthem, Inc. (Temp Work)
09.2016 - 05.2017
  • Maintained compliance with Company and departmental policies, state and federal laws, regulations, and accrediting organization standards by preparing and organizing credentialing files for external audits.
  • Ensured the confidentiality and integrity of the entire credentialing program and process.
  • Facilitated communication with facility personnel, provider relations, Medical Directors, and contractors.
  • Utilized Cactus, Facets, and Maccess systems to execute tasks effectively.

Fleet Coordinator

Avis Budget Group
09.2007 - 07.2011
  • Process paperwork for rental company. Faxed and notarized documents needed for each state. Mailed packages to different states after paperwork and folders were completed. Was promoted and went to damage department where I called customers or locations for Accident Reports
  • Prepared documents for review and billing process
  • Investigated information through field contact-renter or driver information
  • Performed follow-up on all open claim s within a typical 90-day period
  • Met or exceeded production goals and objectives by following strict procedures.

Welder Apprentice

Norfolk Naval Shipyard
06.2003 - 07.2007
  • Assisted senior welders with welding jobs as well as grinding surfaces on submarines and carriers
  • Worked as a team to complete jobs daily, completed environmental safety classes and received college credits for each class. Ran welding lines and hoses thru carriers and submarines as needed.
  • Enhanced welding skills by assisting in various welding projects and learning from experienced welders.
  • Developed strong understanding of industry standards and regulations for safe work practices.
  • Assisted in the preparation of materials before welding, ensuring smooth workflow during production process.
  • Supported team members in completing complex projects through effective collaboration and communication.
  • Removed excess slag with arc-cutting, grinding, and using other equipment.

Education

Master of Arts - Organizational Management

Ashford University
San Diego, CA
10.2011

Bachelor of Science - Interdisciplinary Studies

Norfolk State University
Norfolk, VA
12.2009

Associate of Science - Liberal Arts and General Studies

Tidewater Community College
Norfolk, VA
05.2003

Skills

  • Conflict Management
  • Risk Assessment
  • Licensing Regulations
  • Credentialing
  • License Verification
  • Audit Documentation
  • OSHA Regulations
  • FCVS
  • Microsoft Office Suite (Word, Excel, PPT, Outlook)
  • Smart Sheet/ Spreadsheets
  • Administrative and Office Support
  • Time Management
  • Customer Data Confidentiality
  • Information Verification
  • Records Management
  • License management
  • Teamwork and collaboration
  • Problem-solving
  • Attention to detail
  • Problem-solving abilities
  • Multitasking Abilities
  • Critical thinking

Timeline

Licensing Specialist/ Credentialing Coordinator

Envision Healthcare
09.2021 - 07.2025

Credentialing Specialist

Sentara Healthcare
04.2020 - 04.2021

Credentialing Specialist

Optima Health
06.2018 - 03.2020

Claims Representative

Optima Health
07.2017 - 05.2018

Credentialing Specialist

Anthem, Inc. (Temp Work)
09.2016 - 05.2017

Fleet Coordinator

Avis Budget Group
09.2007 - 07.2011

Welder Apprentice

Norfolk Naval Shipyard
06.2003 - 07.2007

Associate of Science - Liberal Arts and General Studies

Tidewater Community College

Master of Arts - Organizational Management

Ashford University

Bachelor of Science - Interdisciplinary Studies

Norfolk State University

GAPS

Full-time student 

Kimberly J Calloway