Open To Work
KRISTEN RANDOLPH
Frederick
Summary
Dynamic Patient Account Representative with a proven track record at Frederick Health Hospital, excelling in insurance verification and billing resolution. Adept at leveraging analytical skills and effective communication to enhance patient satisfaction and streamline processes. Certified Professional Coder with a commitment to regulatory compliance and exceptional multitasking abilities.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Patient Account Representative
Frederick Health Hospital
07.2025 - Current
- Verified insurance eligibility and benefits for incoming patients daily
- Collaborated with clinical staff to verify coding accuracy, supporting timely reimbursement
- Processed patient billing statements, resolving account discrepancies to enhance patient satisfaction
- Responded to patient inquiries regarding billing and insurance coverage
- Maintained accurate documentation of patient account communications, ensuring compliance with regulations
Provider Relations Representative
United Healthcare
10.2021 - 05.2025
- Maintained accurate provider network data across multiple state regions to ensure reliable access for providers
- Educated providers on claims submission procedures and reimbursement policies
- Investigated and resolved provider payment discrepancies through systematic analysis
- Monitored provider satisfaction metrics and implemented strategies that improved retention rates
- Streamlined communication channels between network providers and internal departments to enhance collaboration
- Responded to provider inquiries regarding eligibility verification and authorization requirements
Prevention Specialist
United Healthcare
11.2016 - 10.2021
- Conducted proactive outreach to providers via phone, managing expectations and supporting initiatives to enhance Net Promoter Score (NPS).
- Resolved escalated provider issues through ISG process, ensuring timely resolutions aligned with provider needs and CMS guidelines.
- Collaborate with supervisors to address urgent concerns submitted by Network Management and Advocacy teams.
- Analyzed reporting on outstanding claims affecting provider abrasion, identifying root causes and collaborating with business partners for process improvements.
- Refer claims to appropriate departments for adjudication in compliance with CMS requirements.
- Deliver clear, detailed education and resolution explanations to providers and customers, consistently promoting service quality.
Resolution Specialist
United Healthcare
10.2013 - 11.2016
- Provided accurate and complete responses to member benefit and claims inquiries, ensuring high-quality customer service.
- Collaborated with Supervisors and Management to resolve complex and escalated member issues.
- Collaborated with Supervisors and Management to resolve complex and escalated member issues.
- Trained Provider Phone Representatives (PPRs) on Gated HMO Intake processes and products, streamlining call handling efficiency.
- Supported call coaching efforts across multiple training classes, enhancing team skills and driving performance improvement.
Provider Phone/Training Support Representative
United Healthcare
05.2008 - 10.2013
- Provided accurate and complete information to members regarding benefits and claims, ensuring a high standard of customer service.
- Supported call coaching efforts in On-the-Job Training (OJT) within Customer Learning Center, enhancing training effectiveness across multiple classes.
- Served as resource in Work-at-Home Floor Walker program, delivering real-time guidance and support to remote representatives, improving service consistency.
- Facilitated cross-functional collaboration in National and Gated HMO call center departments, ensuring consistent service delivery across teams.
- Reviewed referrals and authorizations for medical and behavioral health services to determine appropriate next steps.
- Coordinated with Medical Management to transfer cases requiring additional authorization or referral review.
- Supported key operational initiatives, including the PVO Project and the Medicaid Claims Backlog Project, contributing to process efficiency and timely resolution.
Education
Medical Records -
University of Phoenix
Phoenix, AZ01-2026
High School Diploma -
Northwest High School
Germantown, MD06-2000
Skills
- Insurance billing
- Medical billing
- Billing
- Coding
- HCPCS coding
- Certified Professional Coder (CPC)
- Medical Coding Certification
- Patient accounts
- Insurance verification
- Medical Records Review
- Medical Records
- HIPAA compliance
- Regulatory compliance
- Medicaid
- Medical terminology
- Payment processing
- Auditing
- Google drive
- Microsoft Excel
- Data analysis
- Analytical Skills
- Multitasking
- Time management
- Professionalism
- Effective communication
- Communication
- Active listening
- Effective communication
- Insurance verification
Certification
- Certified Billing and Coding Specialist
Accomplishments
- Member of The The National Society of Leadership and Success
Work Preference
Job Search Status
Open to workWork Type
Full TimeLocation Preference
HybridSalary Range
$45000/yr - $200000/yrTimeline
Patient Account Representative
Frederick Health Hospital
07.2025 - Current
Provider Relations Representative
United Healthcare
10.2021 - 05.2025
Prevention Specialist
United Healthcare
11.2016 - 10.2021
Resolution Specialist
United Healthcare
10.2013 - 11.2016
Provider Phone/Training Support Representative
United Healthcare
05.2008 - 10.2013
Medical Records -
University of Phoenix
High School Diploma -
Northwest High School