Eric T. Nielsen
Sisters,OR
Summary
Dynamic and results-oriented leader dedicated to cultivating a positive and productive work environment. Expertise in recruiting, training, and team development consistently drives enhancements in customer service excellence and operational efficiency. A strong focus on strategic planning and process improvement fosters a culture of accountability and high performance, enabling teams to reach their fullest potential. Recognized for adaptability and a collaborative approach, consistently aligning team goals with organizational objectives to achieve measurable outcomes.
Overview
30
30
years of professional experience
Work History
Manager, Provider Reimbursement
PacificSource Health Plan
Springfield, OR
08.2023 - Current
- Develop and execute strategies for provider network reimbursement functions, ensuring long-term organizational success.
- Oversee reimbursement analysts, ensuring accurate capitation payments, contract implementation audits, and financial analysis.
- Lead continuous improvement initiatives to enhance provider partnerships and operational efficiency.
- Develop policies and procedures related to invoicing, reporting, and various payment methodologies.
- Collaborate with cross-functional teams on provider satisfaction, IT integrations, and strategic reimbursement initiatives.
Manager, Business Operations
Texas Children’s Hospital
Houston, TX
05.2022 - 08.2023
- Managed business operations for member eligibility, provider setup, medical policy configuration, and quality assurance.
- Led process improvement initiatives, ensuring compliance with regulatory mandates and strategic priorities.
- Developed and tracked key performance metrics to drive operational excellence.
- Collaborated with vendors and cross-functional teams to streamline operations and enhance service delivery.
- Provided leadership and coaching to department teams, fostering engagement and professional growth.
Operations Manager
Moda Health (ODS/Delta Dental of Oregon)
Bend, OR
08.2008 - 05.2022
- Directed remote medical claims and customer service operations, ensuring efficiency and compliance.
- Led cross-departmental projects to enhance claims processing accuracy and workflow efficiency.
- Managed operational budgets, developed process improvement strategies, and optimized business functions.
- Served as a liaison between departments to identify system inefficiencies and implement solutions.
Systems Administration Supervisor
Providence Health Plan
Beaverton, OR
11.2002 - 08.2008
- Led system administration teams, overseeing daily production, testing, and quality improvements.
- Provided technical and operational support to ensure system efficiency and business continuity.
- Analyzed system workflows to enhance productivity and streamline processes.
Business Systems Analyst / Group Accountant
Regence BlueCross BlueShield of Oregon
Portland, OR
07.1995 - 11.2002
- Spearheaded system consolidation projects, enhancing efficiency across multiple platforms.
- Defined business requirements, led process improvements, and conducted system testing.
- Provided technical and operational support to streamline business operations.
Education
Bachelor of Science - Health & Human Performance
George Fox University
Newberg, ORSkills
- Team Leadership & Team Development
- Strategic Planning & Execution
- Process Improvement & Optimization
- Operational Management
- Budgeting & Resource Allocation
- Performance Metrics & Analysis
- Cross-Department Collaboration
- Technical & Non-Technical Problem Solving
- Customer Service and Relations
- Decision-making
- Time management
Websites
Timeline
Manager, Provider Reimbursement
PacificSource Health Plan
08.2023 - Current
Manager, Business Operations
Texas Children’s Hospital
05.2022 - 08.2023
Operations Manager
Moda Health (ODS/Delta Dental of Oregon)
08.2008 - 05.2022
Systems Administration Supervisor
Providence Health Plan
11.2002 - 08.2008
Business Systems Analyst / Group Accountant
Regence BlueCross BlueShield of Oregon
07.1995 - 11.2002
Bachelor of Science - Health & Human Performance
George Fox University