Kristy Keesler
Phoenix
Summary
Results-driven Escalations Team Lead with expertise in staff oversight, operational meeting facilitation, and performance metrics tracking. Proven ability to optimize workflows and ensure HIPAA compliance while resolving conflicts effectively.
Overview
14
14
years of professional experience
Work History
Escalations Team Lead
Oscar Health Insurance
Tempe
08.2018 - Current
- Staff Oversight & Leadership: Directed day-to-day operations and provided direct oversight for a team of specialists, serving as the primary point of contact for complex, high-priority service escalations.
- Scheduling & Workforce Management: Managed shift-to-shift staff scheduling, adjusted coverage for unplanned absences, and optimized daily workflows to maintain consistent department throughput and meet performance targets.
- Emergency Authorizations: Spearheaded the review and expedited processing of emergency prior authorizations, coordinating rapidly with medical directors and providers to ensure timely patient care decisions.
- Operational Meetings: Scheduled, structured, and facilitated monthly department meetings to review performance metrics, address operational bottlenecks, and align the team on updated organizational goals.
- Regulatory Compliance & Training: Monitored team workflows to guarantee strict adherence to HIPAA regulations, state/federal insurance laws, and internal compliance benchmarks while executing targeted onboarding and ongoing staff training.
Medical Accounts Receivable
CVS Pharmacy
Phoenix
01.2015 - 08.2018
- Revenue Cycle Management: Managed a high-volume portfolio of outstanding patient accounts, aggressively auditing aging receivables to reduce Days Sales Outstanding (DSO) and maximize cash flow.
- Denial Resolution & Appeals: Investigated, corrected, and appealed complex claim denials and underpayments from commercial, Medicare, and Medicaid payers by identifying root-cause coding or registration errors.
- Payer Relations: Collaborated daily with insurance clearinghouses and claims adjusters to resolve eligibility discrepancies, verify benefits, and expedite delayed reimbursements.
- Financial Counseling & Patient Care: Handled inbound and outbound patient inquiries regarding complex statements, clearly explaining out-of-pocket liabilities, and establishing structured payment plans with high empathy.
Military and Veterans CS Representative
UHC
02.2012 - 01.2015
- Patient Intake & Communication: Fielded a high volume of inbound inquiries from patients, providers, and insurance payers, translating complex medical billing terms and policy details into simple, clear language.
- Demographic & Insurance Verification: Reviewed and verified patient insurance eligibility, updated managed care benefits, and corrected inaccurate demographic profiles to prevent front-end registration errors.
- Conflict Resolution & De-escalation: Diffused high-stress patient inquiries regarding out-of-pocket liabilities, copays, and deductibles with exceptional empathy, maintaining top-tier customer satisfaction ratings.
- Data Integrity & Compliance: Documented detailed interaction notes and updated patient records within the electronic health database.
Education
GED -
Arizona Department of Education
Phoenix, AZ01-2009
Skills
- Staff Oversight & Training
- Operational Meeting Facilitation
- Performance Metrics Tracking
- Workflow Optimization
- Insurance Verification & Eligibility
- HIPAA Regulations & Compliance
- Conflict resolution
Timeline
Escalations Team Lead
Oscar Health Insurance
08.2018 - Current
Medical Accounts Receivable
CVS Pharmacy
01.2015 - 08.2018
Military and Veterans CS Representative
UHC
02.2012 - 01.2015
GED -
Arizona Department of Education