Kristie Roberts
Cumby,TX
Summary
Experienced Licensed Vocational
Nurse and Claims Representative with a robust background in home health care and insurance claims management. Known for exceptional organizational, analytical, and customer service skills, with a proven ability to lead teams, manage complex cases, and enhance operational efficiency. Metrics met with weekly overview.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Licensed Vocational Nurse, Private Duty
At Home Healthcare
07.2015 - Current
- Deliver comprehensive patient care in a home setting, including medication administration, wound care, and routine medical procedures.
- Monitor and document patient health status, ensuring timely communication with physicians and family members.
- Assist with activities of daily living (ADLs), prioritizing patient comfort and safety.
- Collaborate with healthcare providers to develop and execute personalized care plans.
Claims Representative
Progressive Insurance
08.2023 - 05.2024
- Managed the review and processing of insurance claims, ensuring compliance with company policies and regulatory standards.
- Conducted thorough analysis of claim documentation, including medical records and financial reports, to determine eligibility.
- Made informed decisions on claims approval or denial, providing transparent and detailed explanations.
- Maintained accurate records in the claims management system, ensuring all relevant information was meticulously documented.
Insurance Verification Specialist/Charge Nurse
Rock Creek Health And Rehabilitation
06.2014 - 07.2015
- Verified patient insurance coverage, facilitating the accurate and timely processing of claims and pre-authorizations.
- Reviewed insurance documentation to ensure adherence to payer requirements.
- Supervised nursing staff, including task delegation, performance evaluations, and professional development.
- Assessed patient conditions, collaborating with healthcare providers to create individualized care plans.
Education
Nursing -
American Medical Institute
Skills
- Home Health Nursing
- Clinical Documentation
- Insurance Claims Review
- Behavioral Support
- Claims Investigation & Processing
- Care Coordination
- Team Leadership
- Time Management
- Customer Service
- Microsoft Office
Data Entry
Certification
Licensed Vocational Nurse # 312204- TX
Timeline
Claims Representative
Progressive Insurance
08.2023 - 05.2024
Licensed Vocational Nurse, Private Duty
At Home Healthcare
07.2015 - Current
Insurance Verification Specialist/Charge Nurse
Rock Creek Health And Rehabilitation
06.2014 - 07.2015
Nursing -
American Medical Institute