KRYSTAL WARREN
Jefferson
Summary
Dynamic healthcare operations leader with 15+ years of progressive experience across provider pricing, claims adjudication, appeals, and workflow optimization within a TPA environment. Known for building high‑performing teams, strengthening operational accuracy, and driving process improvements that enhance turnaround times and service quality. Adept at partnering with IT, Compliance, and senior leadership to resolve system issues, implement scalable solutions, and standardize departmental procedures. Recognized for developing strong training programs, elevating team performance, and leading with clarity, accountability, and a continuous‑improvement mindset. Ready to step into a broader management role to influence strategy, operational excellence, and organizational growth.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Provider Pricing Supervisor
Health Plans, Inc.
Westborough
01.2017 - Current
- Lead and develop a team of 25 Provider Pricing Specialists and Appeals staff, providing daily coaching, performance management, and long‑term development.
- Foster a collaborative, accountable culture focused on accuracy, efficiency, and continuous improvement.
- Conduct performance evaluations, deliver targeted feedback, and implement performance improvement plans to strengthen team capability.
- Oversee daily provider pricing and appeals operations, ensuring all claims meet strict turnaround‑time requirements and quality standards.
- Monitor inventory, allocate workloads, and adjust staffing priorities to meet fluctuating business demands.
- Identify operational gaps and partner with leadership to implement scalable solutions that enhance workflow efficiency and service quality.
- Partner closely with IT to troubleshoot system issues, validate pricing logic, and implement enhancements that improve accuracy and reduce rework.
- Collaborate with Compliance, Operations, and internal stakeholders to ensure alignment with regulatory requirements and organizational goals.
- Manage complex escalations, conduct root‑cause analysis, and drive long‑term corrective actions.
- Develop, update, and maintain comprehensive training materials, SOPs, and system instructions to standardize processes and support team readiness.
- Designed and implemented a department‑wide training framework that improved onboarding consistency and reduced error rates.
- Ensure strict adherence to HIPAA and internal compliance standards across all team functions.
Team Leader, Provider Pricing
Health Plans, Inc.
Westborough
01.2012 - 01.2017
- Supervised daily work of Provider Pricing Specialists, ensuring accuracy, consistency, and adherence to turnaround‑time requirements.
- Served as the primary escalation point for complex pricing issues, appeals, and provider inquiries.
- Trained new hires and cross‑trained existing staff, contributing to stronger team performance and operational readiness.
- Assisted leadership with workflow planning, reporting, and identifying process improvement opportunities.
- Partnered with IT and Operations to troubleshoot system issues and support enhancements to pricing logic and claims workflows.
Provider Pricing Specialist
Health Plans, Inc.
Westborough
01.2010 - 01.2012
- Processed high‑volume medical, dental, and behavioral health claims with accuracy and compliance to benefit and pricing guidelines.
- Researched and resolved provider pricing discrepancies and appeals.
- Supported network pricing validation and applied appropriate contract terms.
- Contributed to departmental documentation updates and shared best practices to improve team accuracy.
Education
Associate’s Degree - Business Management
Becker College
Worcester, MASkills
- Operational Leadership & Team Development
- Provider Pricing & Appeals Oversight
- High‑Volume Claims Operations
- Workflow Optimization & Turnaround Management
- Cross‑Functional Collaboration (IT, Compliance, Operations)
- Process Improvement & Root‑Cause Analysis
- Policy, SOP, & Training Program Development
- Quality Assurance & Regulatory Compliance (HIPAA)
- Escalation & Issue Resolution
- Performance Management & Coaching
- Javelina & HPAC Systems
- Microsoft Office Suite (Excel, Word, Outlook, PowerPoint)
- Javelina & HPAC Claims Platforms
- Microsoft Excel (formulas, reporting, data tracking)
- Microsoft Outlook & Teams (coordination, scheduling)
- Microsoft Word & PowerPoint (documentation, presentations)
- Workflow tracking tools and internal operational systems
Certification
- Certificate in Interior Design (AutoCAD), 2004
- Director’s Certificate in Early Childhood Education, 2002
- Lead Teacher Certification (Infant, Toddler & Preschool), 2000
Timeline
Provider Pricing Supervisor
Health Plans, Inc.
01.2017 - Current
Team Leader, Provider Pricing
Health Plans, Inc.
01.2012 - 01.2017
Provider Pricing Specialist
Health Plans, Inc.
01.2010 - 01.2012
Associate’s Degree - Business Management
Becker College