Kimberly McKelvey
Tyler,TX
Summary
Experienced and adaptable Credentialing Specialist with 5+ years in healthcare operations and compliance, targeting remote medical administrative positions. Proven ability to manage sensitive healthcare data, navigate insurance and regulatory requirements, and support medical teams through credentialing, billing, and administrative workflows. Technically proficient and a proactive communicator who thrives in independent, fast-paced virtual environments.
Overview
11
11
years of professional experience
Work History
Credentialing Specialist
Humana Insurance Company
01.2021 - Current
- Lead provider credentialing and re-credentialing efforts across multiple states
- Maintain regulatory and documentation compliance for Medicare, Medicaid, and commercial payers.
- Use platforms like CAQH ProView and Salesforce to manage provider profiles and credentialing workflows.
- Serve as liaison between providers, health plans, and internal departments to resolve credentialing issues and meet onboarding deadlines.
- Draft reports and credentialing summaries for auditors and leadership review.
- Ensure data accuracy and confidentiality in compliance with HIPAA standards.
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
Claims Analyst
Centene
11.2016 - 02.2018
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
PAR CVO Intake
Fresenius Medical Center
05.2014 - 11.2016
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Verification of medical insurance and coordination of benefits
- Processed authorizations and referrals
Education
High School Diploma -
Lindale ISD
Lindale, TX05.2008
Skills
- Remote Healthcare Administration
- Medical Credentialing & Enrollment
- Provider Network Compliance
- HIPAA & Regulatory Understanding
- Medical Billing/Coding Terminology
- Electronic Health Records (EHR/EMR)
- Salesforce & CAQH ProView Software
- Cross-Functional Virtual Collaboration
- Time Management & Task Prioritization
- Strong Written & Verbal Communication
- Analytical Thinking & Creative Problem-Solving
- Detail-Oriented Data Accuracy
Timeline
Credentialing Specialist
Humana Insurance Company
01.2021 - Current
Claims Analyst
Centene
11.2016 - 02.2018
PAR CVO Intake
Fresenius Medical Center
05.2014 - 11.2016
High School Diploma -
Lindale ISD
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