Summary
Overview
Work History
Education
Skills
Timeline
Generic

Erica Rojas

Angier,NC

Summary

Experienced administrative professional with 5+ years in provider services. Works productively with facilities, provider groups and individual professionals. Knowledgeable about application requirements for government and private insurance plans.

Overview

15
15
years of professional experience

Work History

Provider Relationship Account Consultant

Elevance Health
04.2020 - Current
  • Responsible for providing quality, accessible and comprehensive service to the company's provider community
  • Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues
  • Collaborates with internal matrix partners to triage issues and submit work requests
  • Generally assigned to a portfolio of providers within a defined cohort
  • Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners
  • Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns
  • Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs
  • Coordinates and conducts provider training including developing and distributing provider relations materials
  • May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues
  • May coordinate Provider Manual updates/maintenance
  • Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery
  • Research issues that may impact future provider contract negotiations or jeopardize network retention.

Bilingual Patient/Insurance Coordinator

Main St Family Dentistry
12.2019 - 03.2020
  • Perform daily practice tasks including opening and closing the business office, posting of payments, taking over-the-counter collections, following up on patients to check on well-being after treatment, verifying insurance coverage before patient's appointments, preparing and presenting morning huddles for potential same day treatment and information on new patients and their insurance (i.e
  • If they have downgrades, can get fluoride, sealants on children, etc.)
  • Engineer the daily schedule from patients calling, walking in and from Revenue Well to maximize our daily goal to best help our patients and practice
  • Work on the daily with insurances whether they're in-network, out of network, DMOs, PPOs, discount plans or also in-house membership programs
  • Work on denied claims with insurances and collecting on patients who owe after insurance deny certain treatment
  • Creating and presenting treatment plans to patients and truly have them understand why they need the treatment
  • Really giving them patient dental education and working with them with financial payment plans, Care Credit and The Lending Club
  • Call patients with pending treatment plans and if possible; propose different treatment plans for them to have options and working with Care Credit and The Lending Club to help them receive their treatment
  • Calling inactive or overdue recall patients
  • Sending out referrals along with x-rays and following up with their Reports and calling patients to get them back in if they need to come back and finish their treatment with us for example: crowns after RTCs or implants and potential extractions on Hopeless teeth and need either extractions and potential replacements plans
  • Most importantly, creating that relationship with patients where they trust you (practice & doctors), leave fully educated on their options and treatment plan and feel in control of their treatment
  • Also work with Six Months Smiles and setting up treatment and payment plans for orthodontic care patients
  • Work with Eaglesoft, Open Dental, Solution Reach and Revenue Well.

Healthcare Specialist/Combat Medic

United States Army National Guard of North Carolina
11.2014 - 11.2019
  • Providing emergency medical treatment, limited primary care, and health protection and evacuation from a point of injury or illness
  • Perform Personal Health Assessments on soldiers and dependents which included taking vitals, writing SOAP notes and relaying information to PA on call
  • Administer emergency medical treatment to battlefield casualties
  • Assist with outpatient and inpatient care and treatment
  • Prepare blood samples for laboratory analysis.

Bilingual Patient Coordinator

Springs Village Dentistry
08.2017 - 07.2018
  • Perform daily practice tasks including opening and closing the business office, posting of payments, taking over-the-counter collections, following up on patients to check on well-being after treatment, verifying insurance coverage before patient's appointments, preparing and presenting morning huddles for potential same day treatment and information on new patients and their insurance (i.e
  • If they have downgrades, can get fluoride, sealants on children, etc.)
  • Engineer the daily schedule from patients calling, walking in and from Revenue Well to maximize our daily goal to best help our patients and practice
  • Work on the daily with insurances whether they're in-network, out of network, DMOs, PPOs, discount plans or also in-house membership programs
  • Work on denied claims with insurances and collecting on patients who owe after insurance deny certain treatment
  • Creating and presenting treatment plans to patients and truly have them understand why they need the treatment
  • Really giving them patient dental education and working with them with financial payment plans, Care Credit and The Lending Club
  • Call patients with pending treatment plans and if possible; propose different treatment plans for them to have options and working with Care Credit and The Lending Club to help them receive their treatment
  • Calling inactive or overdue recall patients
  • Sending out referrals along with x-rays and following up with their Reports and calling patients to get them back in if they need to come back and finish their treatment with us for example: crowns after RTCs or implants and potential extractions on Hopeless teeth and need either extractions and potential replacements plans
  • Most importantly, creating that relationship with patients where they trust you (practice & doctors), leave fully educated on their options and treatment plan and feel in control of their treatment
  • Also work with Six Months Smiles and setting up treatment and payment plans for orthodontic care patients
  • Work with Eaglesoft, Open Dental, Solution Reach and Revenue Well.

Clinical Allergy Specialist

United Allergy Services
09.2016 - 08.2017
  • Coordinate appointments and engineering the daily schedule to best help our patients and practice
  • Test patients for environmental allergies, perform in-office allergy injections, train patients on Epi-Pen usages, make immunotherapy medications
  • Understand allergies and their seasons, symptoms to see what patients are great canidates to be recipients of immunotherapy
  • Verify insurance in reference to allergy procedure codes coverage
  • Order extracts, office supplies and manage all material that goes and comes into allergy clinic.

Patient Coordinator/Billing Specialist

Waterstone Family Dentistry
01.2014 - 05.2016
  • Coordinate appointments and engineering the daily schedule to best help our patients and practice
  • Perform daily practice tasks including opening and closing the business office, posting of payments, taking over-the-counter collections, posting procedures and the batching of insurance claims for processing by the dentist
  • Understand patient treatment plans to ensure the proper completion and scheduling of treatment as well as follow up care
  • This includes insurance coordination and helping patients maximize their insurance benefits as needed
  • Manage patient information including registration, insurance and eligibility information
  • Worked with Dentrix, Open Dental and Solution Reach.

Foreign Language Interpreter II

Cherry Hospital
11.2013 - 05.2014
  • Coordinate service requests for Spanish interpreter and document translation requests utilizing internal staff interpreter resources
  • Supervise the staff interpreter position, assuming responsibility for the growth, development and job performance of the staff in this position
  • Coordinate contract foreign language and contract interpreter services as requested/needed
  • Assess and evaluate the performance of individual contract interpreters
  • Oversee and evaluate all interpreter services contracts
  • Serve as a link for patient treatment teams to ensure that patient communication needs are addressed and adjusted as needed
  • Provide interpreting for Spanish speaking patients admitted to Cherry Hospital
  • Provide interpreting for Spanish speaking patients family members/guardian of patients admitted to Cherry Hospital
  • Service as an effective member of various multi-disciplinary treatment teams
  • Provide therapeutic Spanish interpreting during programming and other special activities as identified by the treatment team and coordinated through the Therapeutic Programming Department
  • Taught English as a Second Language to patients that were admitted to Cherry Hospital and required interpreting services
  • Planned and prepared a curriculum according to their specific needs for when they leave the hospital and into the community and also special specifics were given if the patient had intellectual disabilities
  • Taught Spanish to patients that were admitted to Cherry Hospital
  • Planned and prepared a curriculum according to the patients specific needed for when they leave the hospital and into the community and also special specifics were given if the patient has learning disabilities
  • Translate official hospital forms/documents
  • Translate patient specific documents
  • Interpreted/Translated for Cherry Hospital's court system, their forensic evaluation process and their therapy sessions.

Travel Representative

Hewlett Packard Enterprise Services
07.2011 - 07.2013
  • Travel up to 80% (throughout the state of North Carolina and within 40 miles of the NC border), set up overnight stays, submit weekly expense reports, use company assets appropriately; including fleet vehicle and credit card use, and be accountable of time away from office
  • Schedule/Conduct Medicaid provider visits in an efficient manner
  • Work remote when not traveling
  • Understanding of HCPC codes, Revenue Codes and modifiers
  • Be Point of Contact for seminars
  • Setting up venues, hotels, presenters, material that will be covered and room setup
  • Have exceptional understanding, fully interpret and explain the Basic Medicaid billing guide to providers
  • Continuously keep up-to-date with NC Medicaid changes that occur every month to inform all Medicaid providers with the most accurate and up-to-date information
  • Assist all Medicaid providers with claims resolution within my assigned territory with all of their submitted and denied Medicaid claims
  • Participate and facilitate Medicaid seminars by presenting to large groups of providers either alone or with team, gathering all presentation materials and information, and obtaining the seminar site
  • Work with Department of Medical Assistance and EDS staff to help resolve issues
  • Respond to Dept
  • Of Medical Assistance referrals and phone calls immediately.

Medicaid Eligibility Specialist (Bilingual MAC)

UNC Healthcare
07.2009 - 07.2011
  • Have a full understanding of medical terminology to be able to read medical records and come to a conclusion as to whether or not to pursue Medicaid
  • Conduct face to face interviews with patients and family members and assist patients in applying for N.C
  • Medicaid coverage/one of the ten Medicaid/SSI programs
  • Work predominately with the Hispanic community
  • Assess information gathered from reading a patient's medical records to determine appropriate Medicaid program based on doctor's diagnosis and prognosis
  • Assist patients with their Medicaid applications, follow-up closely with patient's caseworkers at DSS to supply any additional information that is needed to have application approved; also verify that UNCH Medical Records department has sent records to DSS if the application is for a Non-qualified Alien and needs to prove Emergency Services were needed
  • If application is a Disability application then I also follow up with the Disability Determination Services caseworker and that they receive all Medical Records to help them proclaim a patient disabled
  • Create a great rapport with all contact connections that are needed to help application be approved
  • Upon application approvals I will review with patient all that their Medicaid application approval entitles: dates of service, services covered, what deductible they may have, billing questions, and answer any additional questions
  • Upon application denial, abstract information from medical record and Medicaid manual to assist in appeals; drive to DSS to represent the patient from all counties in NC, including representation at Administrative hearings
  • Work from a pool which is a database that holds all accounts for patients that have no insurance and need to be screened for Medicaid.

ESL Parent Facilitator (Spanish)(Pilot Program)

The Harnett County Board of Education
03.2009 - 06.2009
  • Interpreted from English into Spanish and vice versa during IEP (Individualized Education Program) meetings for LEP/ESL (Limited English Proficiency/English as a Second Language) families/children, ESL Parent Nights, and events
  • Prepare presentations for parents and teachers on whatever topic was to be discussed for the month with PowerPoint, Interviews, and Open Discussion nights
  • Traveled up to 60% between three schools that I was in charge of handling on certain days
  • Translate all documents that were to be sent home into Spanish
  • Accompany DSS representative and social workers to children's homes for evaluations and try to make contact with parents
  • Creating ideas in weekly meetings with the ESL Parent Facilitator team members to encourage the Hispanic parents to become more involved with their child's school
  • Help create a positive relationship with the Hispanic community and the school community by creating a great communication rapport by allowing them to call me or to stop by my office whenever they had any questions or ideas
  • Recruiting parents for volunteering and also organizing events for the parents or students.

Education

Bachelor of Arts - Spanish Education

Campbell University
05.2009

Skills

  • Analytical thinking
  • Customer retention
  • Team leadership
  • Problem-solving abilities
  • Networking abilities
  • Conflict resolution
  • Cross-functional collaboration
  • Account management
  • Customer Service
  • Sales forecasting
  • Customer Needs Assessment
  • Staff Training

Timeline

Provider Relationship Account Consultant

Elevance Health
04.2020 - Current

Bilingual Patient/Insurance Coordinator

Main St Family Dentistry
12.2019 - 03.2020

Bilingual Patient Coordinator

Springs Village Dentistry
08.2017 - 07.2018

Clinical Allergy Specialist

United Allergy Services
09.2016 - 08.2017

Healthcare Specialist/Combat Medic

United States Army National Guard of North Carolina
11.2014 - 11.2019

Patient Coordinator/Billing Specialist

Waterstone Family Dentistry
01.2014 - 05.2016

Foreign Language Interpreter II

Cherry Hospital
11.2013 - 05.2014

Travel Representative

Hewlett Packard Enterprise Services
07.2011 - 07.2013

Medicaid Eligibility Specialist (Bilingual MAC)

UNC Healthcare
07.2009 - 07.2011

ESL Parent Facilitator (Spanish)(Pilot Program)

The Harnett County Board of Education
03.2009 - 06.2009

Bachelor of Arts - Spanish Education

Campbell University

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Erica Rojas