Erica Fields
Salem,OR
Summary
Experienced administrative professional with over 20 years of support to high-achieving executives. Efficiently manages high-volume workloads in fast-paced environments with excellent organizational skills. Exceptional people skills and extensive public relations experience contribute to smooth office operations. Strong business acumen and decisive decision-making abilities excel in scheduling, coordinating meetings, managing travel and expense reports, and transcribing minutes.
Overview
6
6
years of professional experience
Work History
Operations Specialist 2
Salem Health
03.2023 - 06.2024
- Successfully managed multiple projects simultaneously while adhering to deadlines and budget constraints.
- Collected, arranged, and input information into database system.
- Utilized advanced analytical skills in order to resolve complex operational issues effectively.
- Analyzed data to identify trends and make informed decisions, driving continuous improvement in operations.
- Improved operational efficiency by streamlining processes and implementing new systems.
- Assisted various departments with change by communicating new improvement plans and expectations.
- Collaborated across departments to identify opportunities for process improvements and increased efficiency.
- Updated tracking spreadsheets using Excel.
- Developed and maintained strong relationships with vendors, ensuring quality service at competitive prices.
Medical Claims Processor
Moda Health
11.2020 - 12.2022
- Entered claims data while interpreting coding and understanding medical terminology in relation to diagnosis and procedures
- Analyze and apply plan concepts to claims that include; deductible, coinsurance, copay, out of pocket, etc
- Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system
- Adjudication of claims to achieve quality and production standards applicable to this position
- Release claims by deadline to meet company, state regulations, contractual agreements and group performance guarantee standards
- Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state and departmental confidentiality guidelines
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
Referral Specialist
Summit Medical Group - BMC
05.2019 - 11.2020
- Identified the referral and authorization requirements of the patients' insurance plans by using various on-line resources according to department workflows
- Verifies insurance eligibility and benefits, and updates the patient's insurance information as necessary
- Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows
- Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request
- Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service
- Ensured that appropriate and accurate information is entered in the patient account
- Collaborates with team members to meet department deadlines and benchmarks
- Maintains patient confidentiality.
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Streamlined referral processes for increased efficiency, resulting in timely appointments for patients.
- Promoted clear communication between primary care providers and specialists through detailed documentation and follow-up calls.
- Developed strong relationships with external healthcare facilities, fostering a collaborative approach to patient care coordination.
- Scheduled appointments with specialists on behalf of clients.
- Contributed to the development of referral policies and procedures, enhancing departmental operations.
Referral Specialist
Mosaic Medical
11.2018 - 05.2019
- Notified health plan and gains financial clearance for plans for patients to undergo a course of care requiring prior authorization.
- Utilized internal and external systems to appropriately request and coordinate prior authorization and referrals for patient care.
- Facilitated the scheduling of patients with internal and external departments, clinics and hospitals.
- Updates and annotates systems with current and accurate information regarding requests for prior authorization and referrals.
- Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
- Built professional relationships with service providers.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to referrals.
- Acted as a liaison between referring physicians and specialists, establishing trust and rapport through professionalism.
- Coordinated multidisciplinary teams during complex cases by sharing relevant patient information among providers.
- Processed referral requests from patients, doctors and other health care professionals.
- Responded to patient inquiries to offer timely updates regarding referral status.
- Monitored referrals to foster timely completion and followed up with physicians to facilitate.
Education
No Degree - General Studies
Chemeketa Community College
Salem, OR01.2001
High School Diploma -
McNary High School
Keizer, OR06.1994
Skills
- MS Office (Word, Excel, Outlook, PowerPoint, Access)
- Professional training in word, excel & situational leadership
- Excellent Communication
- Problem-Solving
- Attention to Detail
- Time Management
- Decision-Making
- Team building
- Relationship Building
- Multitasking Abilities
- Organizational Skills
- Multitasking
- Issue Research
- Interpersonal Communication
- Active Listening
- Idea Development and Brainstorming
- Problem-solving abilities
- Reliability
- Team Collaboration
- Adaptability and Flexibility
- Self Motivation
- Interpersonal Skills
- Time management abilities
- Adaptability
- Multi-task orientated
- Extremely well organized
- Operational Efficiency
- Planning and coordination
- Project Management
- Operations coordination
- Process Planning
Timeline
Operations Specialist 2
Salem Health
03.2023 - 06.2024
Medical Claims Processor
Moda Health
11.2020 - 12.2022
Referral Specialist
Summit Medical Group - BMC
05.2019 - 11.2020
Referral Specialist
Mosaic Medical
11.2018 - 05.2019
No Degree - General Studies
Chemeketa Community College
High School Diploma -
McNary High School
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