Keri Hughey
Pittsburgh,PA
Summary
Healthcare operations professional with 10+ years of experience in health insurance, revenue cycle, claims processing, patient access, customer service, and clinical support. Skilled in insurance verification, benefits investigation, reviewing medical documentation, coordinating with providers and multidisciplinary teams, and resolving complex healthcare and insurance issues while maintaining HIPAA and regulatory compliance. Proven ability to manage high-volume workloads, maintain accurate documentation, and deliver exceptional service in fast-paced healthcare environments.
Overview
5
5
years of post-secondary education
13
13
years of professional experience
Work History
Pharmacy Service Representative
CVS Health
Pittsburgh, PA
10.2025 - 02.2026
- Performed benefits investigations, insurance verification, and prior authorization support while reviewing medical documentation to facilitate specialty medication access.
- Coordinated with providers, health plans, pharmacies, and patients to resolve complex benefit and coverage issues.
- Maintained detailed HIPAA-compliant case documentation while managing a high-volume workload and meeting service expectations.
Medical Assistant
UPMC Mercy
Pittsburgh, PA
05.2025 - 07.2025
- Coordinated scheduling, referrals, patient communication, and clinical workflows while serving as a key point of contact.
- Roomed patients, obtained vital signs, documented medical histories, and assisted providers with examinations and in-office procedures.
Surgical Dental Assistant
University of Pittsburgh School of Dental Medicine
Pittsburgh, Pennsylvania
11.2024 - 02.2025
- Supported oral surgery procedures, coordinated patient care, maintained sterile technique, and ensured patient safety throughout treatment.
- Prepared patients for oral surgery, obtained and documented vital signs, assisted surgeons during procedures, and monitored patient comfort throughout treatment.
Clinical Support Specialist III
UPMC Magee-Womens Hospital
Pittsburgh, Pennsylvania
01.2024 - 05.2024
- Managed scheduling, insurance verification, patient communication, and multidisciplinary coordination.
- Roomed patients, obtained vital signs, prepared exam rooms, assisted providers during patient visits and procedures, and supported efficient patient flow.
Consumer Service Concierge
UPMC Corporate Revenue Cycle
Pittsburgh, Pennsylvania
09.2023 - 12.2023
- Guided community members through applications and healthcare systems while resolving escalated concerns.
- Educated patients on financial responsibilities and available payment options for services.
Contact Center Specialist I
UPMC Community Medicine
Pittsburgh, Pennsylvania
01.2023 - 09.2023
- Scheduled patient appointments and verified insurance information.
- Maintained accurate patient records and Epic documentation.
- Resolved patient account and insurance inquiries efficiently.
Patient Access Representative
UPMC Corporate Revenue Cycle
Pittsburgh, Pennsylvania
08.2021 - 11.2021
- Verified insurance and demographic information while ensuring regulatory compliance and service excellence.
- Scheduled appointments and coordinated patient referrals efficiently.
- Collected and accurately posted patient cash, check, and credit card payments, balanced daily transactions, and reconciled end-of-shift payments while ensuring accurate account documentation.
Medical Claims Examiner
UPMC Health Plan
Pittsburgh, Pennsylvania
01.2020 - 07.2020
- Reviewed Community HealthChoices (CHC) medical claims and supporting documentation to ensure compliance with payer policies and regulatory guidelines.
- Investigated claim discrepancies and analyzed medical documentation to support accurate claims determinations.
- Reviewed EOBs, claim information, and supporting documentation to facilitate timely and accurate claims processing.
- Collaborated with internal departments to resolve claim issues and maintain quality and productivity standards.
Student Information System Specialist
Propel Charter Schools
Pittsburgh, Pennsylvania
07.2017 - 12.2019
- Managed student information systems, trained new staff, created onboarding guides, supported outreach communications, and coordinated school-wide initiatives.
- Maintained data integrity within Student Information Systems.
- Generated reports and analyzed student and operational data.
- Supported system administration, user training, and data documentation.
Sales Support Analyst / Senior Customer Experience Agent
Direct Energy Business
Pittsburgh, Pennsylvania
01.2013 - 06.2017
- Reviewed and analyzed commercial customer contracts to ensure accurate pricing, contract terms, and billing rates, researched discrepancies, and collaborated with Account Managers and Sales to facilitate timely corrections.
- Collaborated with sales teams to streamline communication, resulting in improved operational efficiency.
- Created and maintained reports to support business decision-making.
- Analyzed trends and data quality issues to improve operational efficiency.
- Managed ticketing systems to track customer inquiries, ensuring timely responses and enhanced customer satisfaction.
- Developed training materials for new staff on sales processes and company policies.
- Coordinated cross-departmental meetings to align on project goals and timelines, facilitating better team collaboration.
Education
Dental Assisting Certificate - Dental Assisting
University of Pittsburgh School of Dental Medicine
Pittsburgh, PA 05.2024 - 11.2024
Completed One Clinical Rotation - Nursing
UPMC Shadyside School of Nursing
Pittsburgh, PA 08.2023 - 12.2023
Some Credits (No Degree) - Secondary Education
Clarion University of Pennsylvania
Clarion, PA 08.2007 - 05.2008
High School Diploma - General Studies
West Mifflin Area High School
West Mifflin, PA 08.2003 - 06.2007
Skills
- Health Insurance
- Revenue Cycle Operations
- Claims Processing
- Contract Review & Analysis
- Medical Terminology
- Insurance Verification
- Benefits Investigation
- Medical Documentation Review
- Prior Authorization
- Patient Access & Registration
- Patient Financial Services
- Care Coordination
- HIPAA & Regulatory Compliance
- Customer Service Excellence
- Escalation Resolution
- Epic EMR Cerner EMR SPARx
- Medicare Part C & Part D
- Microsoft Office
- Workflow Coordination
- Data Entry Accuracy
- Team Leadership
- Staff Training & Onboarding
- Cross-Functional Collaboration
- Effective Written & Verbal Communication
CERTIFICATIONS
- DANB Radiation Health & Safety (RHS) | 2024
- DANB Infection Control (ICE) | 2024
Additional Relevant Experience
- Highmark Inc. – Customer Service Benefits Representative (Provider & Member Services) | 2010–2011
- CVS Health (Theracom) /AmerisourceBergen Consulting Services – Senior Data Entry Representative | 2011–2012
- UPMC Falk Medical Clinic – Medical Records Clerk | 2012-2012
Timeline
Pharmacy Service Representative
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
Dental Assisting Certificate - Dental Assisting
University of Pittsburgh School of Dental Medicine
05.2024 - 11.2024
Clinical Support Specialist III
UPMC Magee-Womens Hospital
01.2024 - 05.2024
Consumer Service Concierge
UPMC Corporate Revenue Cycle
09.2023 - 12.2023
Completed One Clinical Rotation - Nursing
UPMC Shadyside School of Nursing
08.2023 - 12.2023
Contact Center Specialist I
UPMC Community Medicine
01.2023 - 09.2023
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
Some Credits (No Degree) - Secondary Education
Clarion University of Pennsylvania
08.2007 - 05.2008
High School Diploma - General Studies
West Mifflin Area High School
08.2003 - 06.2007