Nicole Marshall
Kansas City,MO
Summary
Experienced healthcare administrator specializing in provider credentialing and payer enrollment. Skilled in processing high-volume applications via CAQH, NPPES, and CMS portals, ensuring compliance with NCQA standards and HIPAA regulations. Manage the full credentialing lifecycle, including primary source verification and roster maintenance. Proficient in Salesforce, Facets, and Excel, with a proven ability to quickly learn new platforms to optimize enrollment workflows.
Overview
18
18
years of professional experience
Work History
Data Verification Specialist
CorVel
Overland Park, KS
10.2024 - Current
- Validated high-volume medical and claims data, ensuring accuracy and compliance with internal policies and HIPAA regulations
- Reviewed documentation for completeness and resolved discrepancies to maintain data integrity supporting downstream credentialing and payer enrollment processes
- Applied ICD-10, CPT, and HCPCS codes to support accurate billing and reporting in a fast-paced environment
- Collaborated with internal teams on provider data accuracy; documented issue resolution processes to improve workflow consistency
- Supported bill review operations by assisting with data processing, contributing to operational efficiency improvements
Data Entry Clerk
GDH
Kansas City, MO
06.2022 - 06.2024
- Entered and validated high-volume data with accuracy, reducing errors by 30% and improving processing time by 25%
- Reviewed financial records and documentation to ensure accuracy, completeness, and audit readiness
- Supported data integrity initiatives critical to operational workflows and compliance-driven environments
- Managed confidential client information in strict compliance with HIPAA and data protection standards
- Collaborated cross-functionally to resolve issues, meet deadlines, and maintain organized records for quick retrieval
Provider Data Management Representative
GEHA
Lee's Summit, MO
12.2011 - 06.2021
- Processed provider enrollment, revalidation, and re-credentialing applications in compliance with NCQA, CMS, and regulatory guidelines
- Verified provider credentials through primary source verification (PSV) of licenses, education, and certifications via CAQH and NPPES
- Managed full credentialing lifecycle including provider onboarding, payer enrollment coordination, and ongoing roster maintenance for regional and national payers
- Tracked expiring credentials and licenses to ensure continuous enrollment compliance and prevent network participation gaps
- Partnered with internal teams and payers to ensure timely network participation, minimize enrollment delays, and support new payer implementations
- Responded to provider and internal inquiries regarding credentialing and enrollment status; documented processes to support associate training
- Managed workload to meet strict processing deadlines in a high-volume environment while maintaining HIPAA compliance
General Clerk I / Customer Service Representative
CMI Management
Lee's Summit, MO
06.2008 - 04.2011
- Resolved customer issues by researching and correcting account discrepancies, enhancing customer satisfaction in a fast-paced environment
- Entered and maintained accurate data records within internal systems, ensuring proper filing and compliance with data integrity standards
- Developed foundational skills in data accuracy and customer support, contributing to streamlined processes in high-volume administrative operations
Education
Business Administration - Coursework Completed
Longview Community College
Lee's Summit, MO01-2007
Business Administration - Coursework Completed
Missouri Western State University
St. Joseph, MO01-2006
High School Diploma -
Raytown Sr. High School
Raytown, MO05-2004
Skills
- Data Entry & Data Validation
- Claims Processing & ICD-10 / CPT / HCPCS Coding
- Provider Enrollment & Credentialing (CAQH, NPPES, CMS)
- Payer enrollment
- HIPAA compliance
- NCQA Compliance & Regulatory Standards
- Salesforce & Facets Systems
- Microsoft Office (Excel, Word, Outlook)
- Attention to Detail & Discrepancy Resolution
- Workflow optimization
Timeline
Data Verification Specialist
CorVel
10.2024 - Current
Data Entry Clerk
GDH
06.2022 - 06.2024
Provider Data Management Representative
GEHA
12.2011 - 06.2021
General Clerk I / Customer Service Representative
CMI Management
06.2008 - 04.2011
Business Administration - Coursework Completed
Longview Community College
Business Administration - Coursework Completed
Missouri Western State University
High School Diploma -
Raytown Sr. High School