Q'uiana Kelly
Chicago,IL
Summary
Results-driven contract management professional with extensive experience in healthcare contract administration and provider data management. Proven ability to oversee the entire contract life cycle, ensuring optimal outcomes in healthcare settings. Expertise in analyzing complex data and identifying discrepancies, adept at utilizing tools such as JIRA, SharePoint, and VidaPro to maintain data integrity and streamline processes. Strong leadership and team development skills, committed to continuous improvement and staying current with industry trends.
Efficient Provider Data Specialist known for productivity and swift task completion. Skilled in data management, quality control, and process improvement. Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
6
6
years of professional experience
Work History
Provider Data Specialist
Cook County Health & Hospital
Chicago, United States
08.2022 - 10.2023
- Refined contract labels and rates for Medicaid, Medicare, and Exchange to ensure accurate billing and regulatory compliance.
- Audited provider directories across multiple medical groups, incorporating location terminations as necessary.
- Maintained demographic data integrity using VidaPro, NPESS, and IObserve to support up-to-date provider records.
- Managed provider rosters and SharePoint to maintain data accessibility.
- Verified provider status against state files to ensure operational readiness.
- Translated business requirements into aligned functional solutions to strengthen strategic alignment.
- Confirmed provider specialties and service locations through direct verification with the credentials department.
- Processed provider and facility rosters for Medicaid and Medicare to ensure timely, accurate execution.
- Ensured accuracy and completeness of provider data and directories to boost operational efficiency.
- Reconciled and evaluated provider data across all health plan service systems to protect data integrity.
- Coordinated contract processing through JIRA, enabling smooth mapping and pricing execution.
- Detected and addressed discrepancies within practitioner data to support timely resolution.
Provider Operations Specialist
ELAP Services
Remote
08.2021 - 08.2022
- Supported loading and testing of provider contracts across multiple claims processing systems to ensure accurate configuration and functionality.
- Assisted in the setup of new contracts, fee schedules, amendments, and provider demographic updates in coordination with operations teams.
- Reviewed provider demographic data in collaboration with team members to confirm alignment with reimbursement agreements.
- Audited contract load completions to verify accuracy and adherence to contractual terms.
- Partnered with Provider Engagement to track and implement annual rate updates, ensuring accurate contract adjustments.
- Resolved claims pricing inquiries in coordination with relevant departments to identify root causes and implement solutions.
Contract Administrator
Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas
Chicago, United States
11.2020 - 08.2021
- Assisted providers in navigating internal systems and processes to enhance engagement and on-boarding efficiency.
- Coordinated contract and roster importation in partnership with operational and credentialing teams to ensure seamless integration.
- Aligned project timelines and priorities through effective collaboration with the contracting team.
- Utilized streamlined contract structures and performed roster evaluations to drive network development initiatives.
Contract Coordinator
Aetna, a CVS Health Company
Chicago, United States
06.2019 - 07.2020
- Collaborated with credentialing staff to synchronize provider data and system updates.
- Managed daily operations by compiling, monitoring, and distributing statistical data, while addressing ad hoc reporting needs.
- Structured spreadsheets and databases to optimize data organization, accessibility, and overall efficiency.
Contract Coordinator
Centene Corporation
Chicago, United States
10.2017 - 12.2018
- Analyzed all incoming and outgoing documentation, including directory updates, credentialing applications, contract maintenance forms, and related paperwork to ensure accuracy and completeness.
- Compiled essential credentialing documents for newly contracted providers, enabling timely contract execution by network management representatives.
- Audited configuration loads for new and existing contracts to support efficient contract management, office operations, project workflows, and data analysis.
Supervisor Utilization Management
Aetna Better Health of Illinois
Chicago, United States
11.2013
- Investigated appeals for pre-certified medical services using ICD, CPT/HCPCS coding and clinical documentation to support accurate determinations.
- Managed high call volumes by implementing resource allocation strategies and guiding authorization processes.
- Enhanced organizational efficiency by facilitating information exchange through centralized databases.
- Reviewed denial letters and collaborated with internal teams to ensure timely and accurate resolution of appeals.
- Led cross-functional teams to achieve operational targets and improve response times.
Education
Master of Arts - Healthcare Administration
The University of Arizona Global Campus
Remote12.2025
Bachelor of Arts - Healthcare Administration
The University of Arizona Global Campus
08.2024
Skills
- Microsoft Excel
- Knowledge of Finance
- Managed Care
- Medicare
- Data Analysis
- Spreadsheets
- Auditing Skills
- Project Management
- Microsoft SharePoint
- Data Integrity
- Success Driven Person
- Team Working
- Healthcare Compliance
- Management
Timeline
Provider Data Specialist
Cook County Health & Hospital
08.2022 - 10.2023
Provider Operations Specialist
ELAP Services
08.2021 - 08.2022
Contract Administrator
Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas
11.2020 - 08.2021
Contract Coordinator
Aetna, a CVS Health Company
06.2019 - 07.2020
Contract Coordinator
Centene Corporation
10.2017 - 12.2018
Supervisor Utilization Management
Aetna Better Health of Illinois
11.2013
Bachelor of Arts - Healthcare Administration
The University of Arizona Global Campus
Master of Arts - Healthcare Administration
The University of Arizona Global Campus