Kimberly Arcentales
Oceanside,USA
Summary
Compassionate healthcare professional with a background in psychology and hands-on experience in patient advocacy, insurance navigation, and behavioral health support. Skilled at guiding patients through complex care journeys, resolving barriers to access, and fostering trust through clear and empathetic communication. Adept at balancing digital health tools, human connection, and knowledge of end-to-end to ensure seamless treatment. Recognized for being a fast learner, adaptable in high-autonomy environments, and committed to delivering quality care.
Overview
13
13
years of professional experience
Work History
Manager
Oasis Hair Design
05.2022 - Current
- Translate for Spanish-speaking customers during consultations and all services.
- Demonstrate strong organizational and time management skills while managing multiple projects.
- Coordinate cross-collaboration between a team of eight stylists with varying schedules and specialties, reducing average wait times by 30% and increasing customer and employee satisfaction as well as daily revenue.
- Oversee daily operations, ensuring compliance with company policies and procedures.
Appeals Representative
United Healthcare
02.2023 - 05.2025
- Collaborated with internal teams for the timely resolution of appeals, claims, and pre-service care, reducing delays and preventing lapses in treatment.
- Managed approximately 30 patient or provider claims per day, assuring accuracy of documentation, compliance with state regulations, and outgoing member correspondence with next steps.
- Navigated benefits to determine medical, behavioral health, and dental coverage.
- Monitored AI integration, SOPs, and job aids, ensuring accuracy and correcting any errors.
Administrator
Addiction & Psychiatric Care
11.2021 - 04.2022
- Served as a patient advocate by de-escalating crises and supporting patients and families through care transitions.
- Completed insurance pre-authorizations and coding processes (ICD-10, CPT) to remove care delays and managed intake, follow-ups, and digital records across EMR platforms.
- Streamlined administrative processes, resulting in reduced wait times for patients, and introduced standardized forms, digital workflows, and standard operating procedures for the administrative department.
Community Habilitation Specialist
A-1 Universal Care
06.2021 - 10.2021
- Built long-term patient trust through continued advocacy, empathetic communication, and individualized care planning.
- Designed and reinforced daily routines that balanced independence, safety, and emotional well-being.
Community Habilitation Specialist
Private Family
09.2012 - 06.2021
- Provided direct care and plan management to a boy, from age eleven to twenty, with Williams Syndrome.
- Created an individualized support plan for the development of life and social skills, while empowering independence through monitoring safety skills in society and in the home.
- Enforced a healthy schedule balancing a social life, school, and staying on track with medical requirements.
Skills
Patient Advocacy & Support
Patient Engagement Care Coordination Crisis De-Escalation Trust Building
Healthcare Operations & Digital Tools
Insurance Pre-Authorization Eligibility & Benefits Verification ICD-10 & CPT Familiarity EMR & Telehealth Platforms Virtual Care Tools Asynchronous Communication
Core Strengths
Compassionate Communication Problem Solving Cross-Functional Collaboration Fast Learner / Adaptable
Timeline
Appeals Representative - United Healthcare
02.2023 - 05.2025
Manager - Oasis Hair Design
05.2022 - Current
Administrator - Addiction & Psychiatric Care
11.2021 - 04.2022
Community Habilitation Specialist - A-1 Universal Care
06.2021 - 10.2021
Community Habilitation Specialist - Private Family
09.2012 - 06.2021
SUNY Old Westbury - B.S., Psychology
Education
B.S. Psychology
SUNY Old Westbury, Old Westbury, NY
INTERNSHIPS
Board of Conduct Intern at SUNY Old Westbury (January 2021 - May 2021)
Applied Learning Coordinator
- Developed a campaign schedule for the 2021-2022 school year implementing programs dedicated to mental health, substance abuse prevention, awareness, and sexual and interpersonal violence.
- Created 17 programs per semester and delivered campaigns and prevention initiatives across multiple platforms (email, media, live workshops), refining communication for diverse audiences.
- Led weekly presentations of all campaign and program logistics via Zoom and Microsoft Teams.