Candice K Kelly 3505 Calle Cuervo NW Apt 1324

Albuquerque, NM 87114(505) 270-3522

Objective: My ideal position is one in which I am challenged in a fulfilling environment that enriches my professional growth.

Work History:

2/06 – current BH Provider Service Representative I, Molina Healthcare Input provider adds, changes and terms into Access database.

Submit contracting requests. Educate behavioral health proivders on required contracting and credentialing documents.

Obtain CAQH numbers for providers to access database. Resolve claims issues for providers. Attend provider meetings. Audit rosters. Address fee table issues and how provider is loaded for claims payment resolution.

Provider Information Analyst, Molina Healthcare Receive information from Provider Services and Contracting for configuration of providers into databases to ensure prompt claims payment. Accurately add records with fee schedules and correct contracts. Work pended claims.

Internal Provider Service Representative, Molina Healthcare Input provider additions, changes and credentialing requests into database for 5 Provider Service Representatives. Call providers regarding additional information needed. Assist credentialing department to obtain required information from providers and from Provider Service Representatives. Attend some JOC’s. Travel with Provider Service Representatives to educate providers on what is needed for credentialed and non-credentialed providers. Also post Provider Interest Committee results on SharePoint.

Claims Savings Auditor, Molina Healthcare Work with outside vendor to apply edits to save money on claims payments. Recognize health plan guidelines and reasoning for applying or rejecting edits. Process claims. Meet check run guidelines twice weekly to ensure prompt payments. 5/05 – 2/06 Provider Customer Care Representative, Lovelace Health Plan

Assist providers and members with claims, billing, eligibility, and medical and vision benefit inquiries via telephone and faxed correspondence.

11/02 –5/05 Provider and Member Service Representative, Cimarron Health Plan/ Molina Healthcare Provided service to NM providers in all areas of the health plan. Answered calls from providers and assisted them with claims and billing, eligibility issues, credentialing and contracting questions as well as general account information and correspondence. Also took member calls advising of benefits and eligibility and claim issues.

7/02-11/02 Temporary Employee, Accounting Solutions Filled two temporary positions, one led to my next full time position at Cimarron Health Plan. The other was a short term position as an Administrative Assistant. Duties included sorting mail, answering their multi-line phone and data entry. 6/00 –01/02 General Market Manager, Affinity Management / Entertainment Marketing Inc.

Oversaw the entire Albuquerque Bar Program, had two managers to supervise and up to 12 merchandisers to direct during promotional windows. Responsible for merchandiser interviewing, hiring, training, and maintenance of their paperwork including payroll submission. Other duties included annual recruitment of area venues, negotiating payments from market budget with the venues, their contract submission on the Internet, coordinating and operating promotions, deliveries, shipping and receiving, market research, and weekly paperwork.

10/99 – 6/00 Assistant Market Manager, Affinity Management / Entertainment Marketing Inc.

Duties included assisting the market manager in the responsibilities detailed above as well as being the sweepstakes manager at promotions. At the end of the night a drawing was done for a trip,

and it was my job to keep track of every entry received and observe the legalities associated with the drawing.

9/98 – 10/99 Patient Service Representative, McKesson MedManagementWorked with New Mexico Cimarron Salud HMO Patients. Responsible for their intake process, verification of coverage, finding the durable medical supplies they needed and making delivery orders for these supplies. Gave authorizations to subcontractors all over the state to fill orders that were emergent and could not be sent from our facility. This position also made me familiar with ICD–9 coding.

3/98 – 9/98 Certified Nursing Assistant, Heritage Healthcare Went to patient’s homes and was responsible for personal care, vitals,

meals, errands, light housekeeping and anything necessary to the patient’s well being. Was responsible for making own schedule and

independently following it as well.

6/97 – 2/98 Certified Nursing Assistant, Valle Norte Caring Center Earned CNA here while working on the floor as an NA. Took and passed state test, which involves written and skills testing to earn your

license. Cared for residents by keeping them clean and dry, doingvitals, grooming, and feeding those who needed extra help. Worked

on Alzheimer’s unit which taught me a lot about empathy and patience.

Education: Received diploma from La Cueva High School. Undergraduate

studies at Albuquerque Technical Vocational Institute.

Computer Skills: Microsoft Office, Internet Explorer, Outlook Express and have been able to understand and utilize all programs used in my various

positions. Additional Skills: Due to my experiences I am versatile and have excellent time

management and organizational skills. I am dependable and efficient as well.

References: Molina Healthcare Karen Bounds or Denise Henry 8801 Horizon Blvd NE Albuquerque, NM 87113 (505) 342-4660 Lovelace Health Plan Heather Ingram 4101 Indian School Rd NE Ste 110 Albuquerque, NM 87110 (505) 262-7363

Cimarron Health Plan / Molina Healthcare Yolanda Chavez or Georgiana Orona 8801 Horizon Blvd NE Albuquerque, NM 87113 (505) 342-4660 Accounting Solutions Sandy DuBrock or Cindy Baldwin 4300 San Mateo Blvd NE Ste A-140 Albuquerque, NM 87110 (505) 889-2717 Affinity Management / EMI

Andy Coolidge, Regional Director 360 N Michigan Ave Chicago, IL 60601 (800) 644-0698 Andy’s pager number (877) 346-0543

McKesson MedManagement 4900 Menaul Blvd NE

Albuquerque, NM 87111 (505) 883-1355

Heritage Healthcare 3737 Princeton Drive Albuquerque, NM 87107

(505) 884-3311

Valle Norte Caring Center 501 Alameda

Albuquerque, NM 87113 (505) 823-1885