Krystle Hernandez
Bronx,NY
Summary
Detail-oriented healthcare professional with over 15 years of experience in case management, insurance authorization, and hospital revenue cycle operations. Proven ability to coordinate post-acute and long-term care services, negotiate levels of care with payers, and manage precertifications for Medicare, Medicaid, Workers’ Compensation, No-Fault, and commercial insurance plans. Advanced user of EPIC, QNXT, IDX, CCMS, and QCARE with strong communication, compliance, and patient advocacy skills.
Overview
18
18
years of professional experience
Work History
Case Management
Centers Health Care
Bronx, NY
04.2022 - 08.2025
- Reviewed and submitted clinical documentation for post-acute skilled nursing and long-term custodial care to ensure timely authorizations and regulatory compliance.
- Served as liaison between nursing facilities and insurance providers, negotiating appropriate levels of care.
- Coordinated discharge planning and communicated patient updates with interdisciplinary teams.
- Ensured accuracy of medical and insurance information to prevent delays in placement and reimbursement.
Insurance Specialist
Burke Rehabilitation Hospital
White Plains, NY
09.2017 - 04.2022
- Obtained precertifications for physical, occupational, and speech therapy services.
- Maintained communication with commercial insurers, Medicare, Medicaid, Workers’ Compensation, and No-Fault carriers.
- Reviewed physician referrals and verified benefits and eligibility.
- Utilized EPIC as the primary database.
Level III Customer Service Liaison
Montefiore Medical Center
Yonkers, NY
02.2008 - 09.2017
- Verified insurance information and resolved discrepancies on patient accounts.
- Processed payments and adjustments across IDX, HSR, EPIC, QNXT, CCMS, and QCARE.
- Managed appeals and served as escalation point for inquiries.
- Trained new employees across workflows.
Education
Bachelor of Science - Behavioral Sciences, Health Care Management
Mercy College
Bronx, NY12-2025
College of Mount Saint Vincent
Riverdale, NYSkills
- Case Management & Discharge Planning
- Utilization Review
- Insurance Authorization & Pre-Certification
- Medicare, Medicaid & Commercial Plans
- Appeals & Claims Resolution
- Revenue Cycle Operations
- Patient Advocacy
- Interdisciplinary Communication
- EPIC, QNXT, IDX, CCMS, QCARE
Timeline
Case Management
Centers Health Care
04.2022 - 08.2025
Insurance Specialist
Burke Rehabilitation Hospital
09.2017 - 04.2022
Level III Customer Service Liaison
Montefiore Medical Center
02.2008 - 09.2017
Bachelor of Science - Behavioral Sciences, Health Care Management
Mercy College
College of Mount Saint Vincent