Holly Ketterman
Jefferson Hills,PA
Summary
Diligent administrative professional with strong background in quality coordination and process improvement. Proven track record of enhancing operational workflows and ensuring compliance with industry standards. Demonstrated ability in problem-solving and effective communication within cross-functional teams. Quality professional committed to maintaining high standards and achieving results. Expertise in improving operational processes and ensuring compliance with regulatory requirements. Known for strong team collaboration and adaptability to changing needs. Skilled in quality control methodologies and process optimization.
Overview
26
26
years of professional experience
Work History
Quality Coordinator / Regulatory Affairs
CORE - Center for Organ Recovery and Education
02.2024 - Current
- Perform audits/process organ/tissue charts to ensure they're compliant with regulations
- Outreach to Medical examiners, hospitals, EMS companies, etc
- To obtain medical records
- Use data collection and data entry to maintain files and provide quality corrections
- Apply proper reporting and accountability protocols to ensure satisfactory resolution
- Work closely with management providing insight to address needs and insight on improvement on the Customer Care function
Clinical Administrative Coordinator
Optum HCBS Support
10.2014 - 02.2024
- Collaborate on team growth participating in work groups, team training, and supporting change
- Assist in facilitating team meetings/ presentations along with organization in creating SOP's
- Demonstrated competency and strong decision-making skills to solve complex matters
- Implement innovation in our operations process to eliminate reduction in errors and improve quality
- Coordinate with staff members, clinical team, and hospitals to resolve issues
- Manage and review SOP's for medical/clinical services following department policies
- Verifies insurance information through payer contacts through telephone, online resources, electronic verification system
- Identifies payer authorization/referral requirements Provides appropriate documentation and follow up to physician offices and case management department regarding authorizations
Clinical Administrative Coordinator
UnitedHealth Group
06.2010 - 10.2014
- Use of strong communication skills to manage high volume que line for multiple lines of business
- Navigate platforms to determine need for medical services following regulatory processes
Customer/ Provider Service and Claims Specialist
UnitedHealth Group
04.2009 - 06.2010
- Resolve billing/payment issues while accessing/processing claims and EOB's
- Manage provider/ member matters following notification requirements and review of benefit coverage
- Received escalated emails to address root concerns and resolve issues
Office Manager
JLJ Inc/J&B Construction
12.2004 - 12.2008
- Create bills of sale, lease agreements, invoices, and contracts
- Supervision over Accounts Payable/Receivable and payroll and quarterly tax reports
- Coordinate various meetings and appointments
- Maintain expense reports, memberships, and subscription renewals
Utilization Management Assistant
Three Rivers Administrative Services
08.2001 - 05.2004
- Managing admission/discharge information, referral processes and prior authorizations
- Prepared daily, weekly, and monthly computerized reports
- Supervision and proofreading over denial letters and generation
- Assist other departments with claims processing for inpatient/ outpatient services
Administrative/Medical Assistant
Jefferson Hospital Regional Medical Center
08.1998 - 05.2001
- Prepared patient charts and schedule appointments
- Performed ICD 9 and CPT 4 to assist with hospital/ medical claims
- Follow Medicaid and Medicare regulations
- Obtained pre-certifications for outpatient and inpatient services
- Mastered software to handle patient scheduling and billing
Education
Associate of Applied Science - Medical Assisting
Western School of Health And Business
Monroeville, PASkills
- Training and development
- Preventive actions
- Corrective actions
- Change control procedures
- Customer service
- Quality training
- Quality tools
- Critical thinking skills
- Relationship building
- Quality metrics
- Internal auditing
- Policy and procedure implementation
- Documentation management
- Audit compliance
- Strong work ethic
- Team collaboration
- Employee training
- Effective multitasking
Timeline
Quality Coordinator / Regulatory Affairs
CORE - Center for Organ Recovery and Education
02.2024 - Current
Clinical Administrative Coordinator
Optum HCBS Support
10.2014 - 02.2024
Clinical Administrative Coordinator
UnitedHealth Group
06.2010 - 10.2014
Customer/ Provider Service and Claims Specialist
UnitedHealth Group
04.2009 - 06.2010
Office Manager
JLJ Inc/J&B Construction
12.2004 - 12.2008
Utilization Management Assistant
Three Rivers Administrative Services
08.2001 - 05.2004
Administrative/Medical Assistant
Jefferson Hospital Regional Medical Center
08.1998 - 05.2001
Associate of Applied Science - Medical Assisting
Western School of Health And Business
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