Candice K Kelly has over 20 years of experience in healthcare administration and customer service. She has held various roles at Molina Healthcare, Lovelace Health Plan, Cimarron Health Plan, McKesson MedManagement, and other organizations. Her experience includes provider relations, claims processing, credentialing, data entry, and customer service. She has strong computer skills and is proficient in Microsoft Office.

1. 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.

2. 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 MedManagement
Worked 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

3. 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, doing
vitals, 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

4. 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