Kristen Crutchfield
San Antonio
Summary
Dynamic individual with hands-on experience in configuration and IT operations. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.
Overview
10
10
years of professional experience
Work History
Claims Specialist
WebTPA
12.2024 - Current
- Achieved and maintained monthly performance metrics for healthcare claims processing and resolution, ensuring efficiency and accuracy within company platforms.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Oversee claims investigations, analyze medical records, address Department of Insurance appeals, and authorize payments to claimants and providers.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
Operations Support Analyst / Configuration Specialist
CFHP
06.2023 - 10.2024
- Configured and implemented updates and new features in QNXT/Cognizant, ensuring seamless integration and functionality
- Applied in-depth knowledge of subsystems including QNXT, and Microsoft technologies to troubleshoot and enhance system performance
- Assessed the impact of proposed changes and evaluated required adjustments to optimize system operations and maintain security
- Streamlined operations by identifying inefficiencies and implementing process improvements.
Claims Specialist
WebTPA
11.2022 - 06.2023
- Efficiently processed, reviewed, and adjusted insurance claims for medical, dental, and mental health services, ensuring accuracy and compliance
- Consistently achieved deadlines for overpayment recovery initiatives while delivering exceptional customer service
- Conducted in-depth research on claim appeals and benefit standards, leveraging various systems and reports to support accurate claim adjudication
Healthcare Claims Specialist
VillageMD
03.2021 - 10.2022
- Acted as a subject matter expert for high-value and high-risk claims, providing critical insights and guidance to ensure accuracy and risk management
- Partnered with management and leadership to develop and implement new training and development programs, enhancing team skills and knowledge
- Streamlined reporting and claim review processes, implementing optimizations that reduced operational inefficiencies and improved overall workflow
Configuration Specialist
First Care Health Plans
02.2018 - 05.2019
- Conducted comprehensive audits of Medicare Fee schedules for compliance and contract updates using NotePad++ for diverse supplier types, including Out-of-Network (OON), In-Network (INN), Medicaid, Medicare, PPO, and HMO plans
- Tested new contracts within the Designer HealthRules/HealthEdge environment by executing test claims to ensure accuracy and functionality
- Consistently met daily deadlines for fee schedule updates across multiple Medicaid markets, demonstrating strong time management and organizational skills
- Led and supported large-scale ad-hoc projects aimed at enhancing training, improving processes, and advocating for customer needs, contributing to overall operational efficiency
Claims Analyst
United Healthcare
05.2015 - 02.2018
- Consistently surpassed departmental metrics for Medicaid and Medicare claims review by meticulously validating claim details against health plan requirements
- Led targeted projects to address and reduce overdue, high-risk claims, while training experienced analysts on the Facets system to enhance process efficiency
- Supported Subject Matter Experts in on-boarding and training new analysts in the claims department, facilitating knowledge transfer and ensuring team proficiency
Education
Certificate of Completion - Cybersecurity
UTSA Cybersecurity Bootcamp
05.2024
High School - undefined
Medina Valley High School
Skills
- IT Operations
- Implementation
- Operating System Configuration
- Project Coordination
- Skilled in using Microsoft Office tools
- Windows OS
- Cross-functional collaboration
- Training
- Risk Analysis
- Report Analysis
- Time management
- Multitasking
Timeline
Claims Specialist
WebTPA
12.2024 - Current
Operations Support Analyst / Configuration Specialist
CFHP
06.2023 - 10.2024
Claims Specialist
WebTPA
11.2022 - 06.2023
Healthcare Claims Specialist
VillageMD
03.2021 - 10.2022
Configuration Specialist
First Care Health Plans
02.2018 - 05.2019
Claims Analyst
United Healthcare
05.2015 - 02.2018
Certificate of Completion - Cybersecurity
UTSA Cybersecurity Bootcamp
High School - undefined
Medina Valley High School
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