Keri Hughey
Pittsburgh,PA
Summary
Healthcare operations and revenue cycle professional with experience in billing, claims review, and payer coordination across hospital and specialty pharmacy settings. Proven ability to analyze and resolve complex billing and insurance issues, identify root causes of claim errors, and support process improvements to enhance reimbursement and workflow efficiency. Skilled in cross-department collaboration, regulatory compliance, clinical experience and maintaining accurate patient and financial records in high-volume healthcare environments.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Pharmacy Service Representative (PSR)
CVS Health
Remote
10.2025 - 02.2026
- Analyze and resolve complex medication access, benefit, and prior authorization issues, identifying root causes of payer rejections and delays in processing.
- Collaborate cross-functionally with patients, providers, and payers to resolve claim discrepancies and ensure timely and accurate prescription processing.
- Reviewed and maintained accurate, HIPAA-compliant documentation while ensuring adherence to payer policies and regulatory requirements in a high-volume specialty pharmacy environment. Identify recurring insurance and billing issues and contribute to workflow improvements to reduce claim rejections and processing delays.
Medical Assistant
UPMC Mercy
Pittsburgh, PA
05.2025 - 07.2025
- Provided direct patient care including vitals, EKGs, and specimen processing in a fast-paced clinical setting.
- Assisted providers during in-office procedures while maintaining sterile technique and patient safety standards.
- Documented encounters in EMR and supported referrals, authorizations, and overall clinic workflow coordination.
Surgical Dental Assistant
University of Pittsburgh School of Dental Medicine
Pittsburgh, PA
11.2024 - 02.2025
- Assisted oral and maxillofacial surgeons during complex procedures under anesthesia.
- Maintained sterile surgical environments and monitored patient vitals.
- Supported surgical team workflow and post-operative patient care.
Clinical Support Specialist III
UPMC Magee-Womens Hospital
Pittsburgh, PA
01.2024 - 05.2024
- Supported clinical and operational workflow within a high-volume breast imaging department.
- Coordinated diagnostic scheduling and verified insurance eligibility to prevent care delays.
- Served as liaison between patients, technologists, and providers to resolve workflow issues.
- Ensured HIPAA compliance, documentation accuracy, and follow-up coordination.
Consumer Service Concierge
UPMC Corporate Revenue Cycle
Remote Pittsburgh, PA
09.2023 - 12.2023
- Analyzed and resolved complex billing, insurance, and financial assistance inquiries, identifying trends and contributing to improved resolution processes.
- Served as an escalation point for sensitive financial concerns.
- Educated patients on coverage and payment options.
Patient Access Representative
UPMC Corporate Revenue Cycle
Pittsburgh, PA
08.2021 - 11.2021
- Supported patient registration, insurance verification, and scheduling.
- Ensured accuracy and compliance during check-in and discharge.
- Maintained patient flow and operational efficiency.
Medical Claims Examiner
UPMC Health Plan
Remote, Pittsburgh PA
01.2020 - 07.2020
- Reviewed and validated medical claims documentation to ensure compliance with coverage guidelines, while identifying discrepancies and supporting accurate reimbursement.
- Determined coverage, calculated benefits, and issued determinations.
- Communicated findings to stakeholders.
Student Information System Specialist
Propel Charter Schools
Pittsburgh, PA
07.2017 - 12.2019
- Managed the Student Information System (SIS), ensuring accurate grade entry, correcting clerical errors, and supporting state reporting compliance.
- Provided technical support across multiple school sites, troubleshooting software, hardware, and network issues to maintain operational continuity.
- Trained staff on system updates and developed user guides to improve workflow efficiency.
- Supported data reporting, onboarding processes, and administrative operations to ensure accuracy and compliance.
Sales Support Analyst / Senior Customer Experience Agent
Direct Energy Business
Pittsburgh, PA
01.2013 - 06.2017
- Reviewed and validated commercial electricity and natural gas contracts, correcting pricing and clerical errors prior to execution.
- Educated business customers on kWh usage, natural gas consumption, and pricing structures to improve billing transparency and retention.
- Created custom pricing models tailored to client needs, maximizing deal closure without compromising margins.
- Supported senior leadership with reporting and operational insights; promoted into senior role based on performance.
- Trained and onboarded new Sales Support Analysts and provided timely sales reporting to support informed decision-making.
Education
Dental Assisting Certificate - Dental Assisting
University of Pittsburgh School of Dental Medicine
Pittsburgh, PA11.2024
Nursing Program - One Clinical Rotation Completed
UPMC Shadyside
Pittsburgh, PASecondary English Education - Secondary English Education Coursework
Pennsylvania Western University
Clarion, PAHigh School Diploma -
West Mifflin Area High School
West Mifflin, PA06.2007
Skills
- Team Support & Informal Leadership
- Revenue Cycle & Patient Access Operations
- Regulatory & Compliance Oversight
- Root Cause Analysis & Process Improvement
- Data Verification & Record Accuracy
- Staff Training & Onboarding Support
- Escalation & Issue Resolution
- Epic / EMR Systems/ Microsoft Office
- Workflow Optimization
- Quality, Accuracy & Compliance
- Cross-Department Collaboration
- Healthcare Scheduling Platforms
- Insurance & Revenue Cycle Systems
- HIPAA-Compliant Documentation
Certification
- DANB Radiation Health & Safety (RHS), PA – Effective 10/15/2024
- DANB Infection Control (ICE) – Effective 10/15/2024
- BLS/CPR
- AED
Timeline
Pharmacy Service Representative (PSR)
CVS Health
10.2025 - 02.2026
Medical Assistant
UPMC Mercy
05.2025 - 07.2025
Surgical Dental Assistant
University of Pittsburgh School of Dental Medicine
11.2024 - 02.2025
Clinical Support Specialist III
UPMC Magee-Womens Hospital
01.2024 - 05.2024
Consumer Service Concierge
UPMC Corporate Revenue Cycle
09.2023 - 12.2023
Patient Access Representative
UPMC Corporate Revenue Cycle
08.2021 - 11.2021
Medical Claims Examiner
UPMC Health Plan
01.2020 - 07.2020
Student Information System Specialist
Propel Charter Schools
07.2017 - 12.2019
Sales Support Analyst / Senior Customer Experience Agent
Direct Energy Business
01.2013 - 06.2017
Dental Assisting Certificate - Dental Assisting
University of Pittsburgh School of Dental Medicine
Nursing Program - One Clinical Rotation Completed
UPMC Shadyside
Secondary English Education - Secondary English Education Coursework
Pennsylvania Western University
High School Diploma -
West Mifflin Area High School