Kyra King
Jonesboro,GA
Summary
Detail-oriented healthcare professional with extensive experience in data entry and credentialing processes, currently serving as a Provider Enrollment Specialist at United Health Group's Optum division. Proven ability to review and verify credentials, perform data enrichment tasks, and maintain high-quality standards in compliance with industry regulations. Excellent organizational and communication skills, with a commitment to accuracy and efficiency in managing healthcare data.
Overview
11
11
years of professional experience
Work History
Provider Enrollment Specialist
United Health Group, Optum
Atlanta, GA
08.2023 - Current
- Supported data enrichment tasks related to provider credentialing, ensuring compliance and accuracy throughout the application lifecycle.
- Developed and executed action plans to resolve credentialing issues efficiently, maintaining thorough documentation for transparency and regulatory alignment.
- Ensured seamless enrollment aligning with Medicare, Medicaid, and private payer standards
- Oversaw eligibility and credentialing validations for timely application processing
Patient Care Coordinator
United Health Group, Optum
Atlanta, GA
08.2022 - 08.2023
- Assisted with answering chats from patients and maintaining files, logs, or other reports
- Verified insurance eligibility and obtained benefits for scheduled patient accounts using electronic verification systems or by contacting payers directly.
- Documented insurance benefit information including deductibles, co-payments, coinsurance, and policy limitations
- Secured or verified authorization and pre-certification for medical services
- Completed medical necessity checks for outpatient services when Medicare is the payer, using provided diagnosis and procedure codes
Eligibility Representative
United Health Group, Optum
Atlanta, GA
02.2022 - 08.2022
- Communicated with patients and hospital administrators over the phone to address eligibility concerns and provide answers to eligibility inquiries
- Obtained referrals and preauthorizations through communication with insurance companies or utilization of insurance company portals
- Ensured the precision of enrollments by verifying group numbers, plan details, and effective dates as reported by health plans
- Entered precise fee-for-service eligibility and benefits data for non-HMO members (PPO, EPO, Medicare, and POS) into the system
- Conducted research on insurance coverage for newly unverified members ahead of scheduled appointments and relayed findings
Disenrollment Representative
Humana Insurance Company
Charlotte, NC
08.2021 - 01.2022
- Handled 40-60 inbound calls daily within a high-volume inbound call center environment
- Cultivated favorable customer relationships, collaborating with team members to efficiently address disenrollment and cancellation inquiries
- Conducted thorough research to assist members, identified representation needs, and resolved issues to deliver optimal member support
- Ensured precision and enhanced accuracy of medical records across CMS and multiple databases
- Elevated unresolved and pending customer grievances to ensure effective resolution
Senior Regulatory Specialist
Department Of Business & Professional Regulation
Tallahassee, FL
02.2019 - 07.2020
- Responded to inquiries regarding application status and deficiencies through written correspondence and telephone communications
- Reviewed and processed over 300 applications monthly, submitted by construction industry contractors for certification and license/permit issuance per the Florida Statutes
- Demonstrated strong analytical and problem-solving skills by meticulously verifying experience, education, credit reports and background checks
- Conducted interviews and provided assistance to construction industry applicants in completing applications and acquiring necessary information for the issuance of registration certificates/licenses
Regulatory Specialist I & II
Department Of Business & Professional Regulation
Tallahassee, FL
11.2017 - 02.2019
- Achieved promotion from Regulatory Specialist I to Regulatory Specialist II within a remarkable 4-month timeframe
- Handled 30-70 incoming calls daily in Customer Contact Center, accurately addressing customer inquiries in alignment with departmental policies, Florida Statutes, and regulations
- Provided comprehensive licensing status information and addressed inquiries from more than 25 nonmedical professions regarding licensing matters, requirements, continuing education, and license renewal fees
- Utilized various resources, including call center systems, intranet, internet, and statutory laws, to provide accurate responses to customer inquiries
- Maintained up-to-date and precise information in call center systems, ensuring accuracy in licensee details and resolution of customer inquiries
- Demonstrated thorough understanding and application of applicable rules, policies, and procedures related to professional licensure and regulation, ensuring consumer protection within regulated professions
Customer Service Representative
Verizon Wireless
Tallahassee, FL
11.2016 - 10.2017
- Responded to customer inquiries via phone, email, and chat in a high volume call center environment, addressing inquiries related to phone billing, upgrades, and technical support
- Diagnosed and resolved customer concerns promptly while offering technical guidance in a timely fashion
- Enhanced retail sales and provided exceptional customer service tailored to individual customer expectations
- Strengthened client connections by employing effective questioning techniques to understand unique needs and preferences
Sales Associate Trainer
Old Navy
Tallahassee, FL
10.2013 - 10.2016
- Provided comprehensive training, coaching, and mentorship to new sales associates to optimize their performance
- Demonstrated exceptional sales performance by consistently surpassing sales targets through proactive identification and pursuit of new opportunities
- Addressed customer inquiries regarding products and services, facilitated merchandise location, and promoted key items to enhance sales
- Orchestrated the replenishment of sales floor inventory with current merchandise and ensured accurate signage for ongoing promotions
- Oversaw efficient cash register operations to maintain smooth transaction processes and customer satisfaction
Education
Dental Assisting -
Tallahassee Community College
Tallahassee, FL06.2021
High School Diploma -
Englewood High School
Jacksonville, FL06-2012
Skills
- Data Entry & Management
- Exceptional Customer Care
- Detail-Oriented Focus
- Compliance Management Skills
- Strong Written and Verbal English Skills
- Analytical and Critical Thinking
- Effective Time Management
- Spreadsheet Management
Timeline
Provider Enrollment Specialist
United Health Group, Optum
08.2023 - Current
Patient Care Coordinator
United Health Group, Optum
08.2022 - 08.2023
Eligibility Representative
United Health Group, Optum
02.2022 - 08.2022
Disenrollment Representative
Humana Insurance Company
08.2021 - 01.2022
Senior Regulatory Specialist
Department Of Business & Professional Regulation
02.2019 - 07.2020
Regulatory Specialist I & II
Department Of Business & Professional Regulation
11.2017 - 02.2019
Customer Service Representative
Verizon Wireless
11.2016 - 10.2017
Sales Associate Trainer
Old Navy
10.2013 - 10.2016
Dental Assisting -
Tallahassee Community College
High School Diploma -
Englewood High School
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