Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

KIERSTEN PETTY

Spring,TX

Summary

Experienced healthcare professional with a passion for delivering high-quality results all while using analytical skills to focus on solutions. Skilled in problem-solving and analysis, able to work effectively both independently and as part of a team. Proven track record of building successful solutions and fostering positive relationships in diverse healthcare settings.

Overview

15
15
years of professional experience
1
1
Certification

Work History

Clinical Administrative Coordinator

UNITED HEALTHCARE
08.2022 - Current
  • Conduct initial and concurrent reviews independently with in Utilization Management Review department
  • Collaborate with assigned facilities, doctors and nurses daily in regards to authorizations obtained
  • Intake for Inpatient Behavioral Health admits and Outpatient services
  • Knowledge and understanding of step down process per ASAM criteria ,treatment types and patient diagnosis
  • Provide updates, maintains and/or closes authorizations or tasks for services as assigned within process guidelines
  • Process incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines. Refers episodes to the appropriate clinical team members for review
  • Obtain necessary clinical documentation for initial and ongoing reviews in a professional manner
  • Respond promptly to assigned facilities to answer concern in regards to status of authorization request
  • Actively coordinates with other staff such as case managers, nurses and physicians
  • Document in the electronic system daily in real time.
  • Assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes
  • Maintains strict confidentiality and adhered to HIPAA guidelines and regulations
  • Remote

Customer Care and Claims Representative

AETNA, a CVS Company
07.2019 - 07.2022
  • Reviews claims in accordance with claim processing guidelines
  • Liaise between patients, providers, pharmaceutical representatives and medical centers to align objectives and positive resolution for the patient
  • Intake for appeals and authorizations
  • File grievances and complaints
  • Document calls and members account with thorough, concise and accurate updates and notation.
  • Provide customer service to the aged population
  • Assist with members medical benefits
  • Coordinate and provide member behavior health resources
  • Handle faxing electronic documents
  • Facilitate virtual meetings
  • Remote
  • Resolved customer inquiries and disputes, ensuring timely communication and satisfaction.
  • Collaborated with cross-functional teams to streamline claims processing procedures.
  • Analyzed trends in claims data to identify opportunities for process improvements.
  • Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
  • Conducted thorough audits to identify discrepancies in claims processing.

Customer Service Representative

AT&T
12.2012 - 06.2019
  • Answer numerous inbound calls each day in a call center environment handling various concerns, process payments, and view customer account history
  • Analyzed financial transactions, credit information, and payment histories
  • Contacted credit agencies, banks, and other financial institutions to verify or gather data
  • Analyzed customer payment histories and issued denials and approvals based on credit-worthiness
  • Analyzed customer credit feasibility according to established standards and company policy
  • Communicated with supervisors to escalate issues and resolve complex errors
  • Communicated with credit applicants to validate provided info and request additional information needed to process applications
  • Meet inbound customer needs while maintaining strict performance targets.

Patient Care Coordinator

NURSE COMMUNICATIONS AFTER HOURS INC.
11.2010 - 11.2012
  • Liaison support for patients and medical staff
  • Meticulous documentation for each call for provider offices after hours to follow up next business day
  • Coordinated effective interdepartmental collaboration through open communication between medical staff.
  • Coordinate and assist with scheduling home health aids to patients home, patient deliveries from durable medical companies

Education

Highschool Diploma - General Education

Etiwanda
Rancho Cucamonga, CA
06.2002

Associate in Science (A.S.) - Health Administration

Lonestar College
Houston, TX
12-2026

Skills

  • CMS regulatory expertise
  • Utilization management assessment
  • Clear and concise communication
  • Knowledge of Behavioral Disorders and Treatment Types
  • Proficient in ICD-10 diagnosis coding
  • Knowledge of clinical terminology
  • Patient communication
  • Benefits/Coverage determination
  • Coordinating
  • Experience with electronic health records
  • Detail-oriented data management
  • Problem-solving skills
  • Compliance awareness
  • Claims processing
  • ICD-10 proficiency

Certification

BLS (CPR and AED)

Languages

English
Full Professional

Timeline

Clinical Administrative Coordinator

UNITED HEALTHCARE
08.2022 - Current

Customer Care and Claims Representative

AETNA, a CVS Company
07.2019 - 07.2022

Customer Service Representative

AT&T
12.2012 - 06.2019

Patient Care Coordinator

NURSE COMMUNICATIONS AFTER HOURS INC.
11.2010 - 11.2012

Highschool Diploma - General Education

Etiwanda

Associate in Science (A.S.) - Health Administration

Lonestar College

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