Ericka Collier
Madison,AL
Summary
Healthcare support professional with experience in member services, prior authorization, insurance verification, and claims analysis in fast-paced medical settings. Handles high-volume calls, explains benefits and claim decisions, documents interactions under HIPAA, and uses EHR/EMR and payer systems to resolve billing issues and authorization questions with accuracy.
Overview
12
12
years of professional experience
Work History
Member Services Representative
Ensemble
06.2023 - Current
- Handle high-volume inbound and outbound calls (60–100+ daily) assisting members, patients, and providers with benefit inquiries, eligibility, and claim status
- Verify insurance coverage, demographics, and authorization requirements to ensure accurate processing and service delivery
- Explained plan benefits, EOBs, and claim determinations clearly and professionally, enhancing member understanding and satisfaction
- Resolved claim issues including denials, delays, and billing discrepancies by leveraging internal systems and payer guidelines to ensure accurate and timely outcomes
- Navigate multiple systems (claims platforms, CRM tools, and payer portals) to access and update account information efficiently
- Escalate complex issues to appropriate departments while maintaining ownership through resolution
- Meet or exceed performance metrics including quality scores, AHT, first call resolution, and productivity targets
Senior Member Services Representative
Neurology Consultants
08.2018 - 06.2023
- Handle escalated calls involving billing disputes, claim denials, prior authorizations, and coverage concerns with a focus on resolution
- Serve as a subject matter expert (SME) for complex members, provider, and claim-related inquiries, supporting front-line representatives
- Review and analyze claim issues, identifying root causes and coordinating with claims, billing, or clinical teams for correction
- Act as a liaison between departments to resolve high-impact or time-sensitive issues affecting members or providers
- Monitored call quality and provided actionable feedback to enhance team performance, customer experience, and compliance adherence
- Ensure accurate and detailed documentation of escalations, trends, and resolutions within internal systems
- Identified workflow gaps and recommended process improvements for leadership, contributing to enhanced operational efficiency
- Trained and onboarded new hires on call handling, system navigation, and compliance standards to ensure effective performance
Prior Authorization Specialist
UAB Huntsville Regional Medical Campus
07.2014 - 08.2018
- Reviewed and processed prior authorization requests for medical services, procedures, and medications, ensuring accuracy and completeness of documentation to support timely patient care
- Verified member eligibility, benefits, and coverage requirements prior to authorization determination
- Communicated with providers, clinical staff, and internal departments regarding authorization status, missing documentation, and follow-up requirements to facilitate prompt resolution of requests
- Entered and updated authorization information within internal systems while maintaining accurate documentation and audit readiness
- Reviewed CPT, ICD-10, and HCPCS codes to support authorization review and claim accuracy
- Handled inbound and outbound calls regarding authorization requests, denials, approvals, and service coordination, effectively addressing inquiries to enhance member and provider experience
- Handle high-volume inbound and outbound calls (60–100+ daily) assisting members, patients, and providers with benefit inquiries, eligibility, and claim status
Education
Bachelor of Science - Communications
Alabama A&M University
Normal, AL01-2014
Skills
- Insurance Verification
- Eligibility Verification
- Benefits & Eligibility
- Authorization process
- Claim Resolution
- High-volume call handling
- Patient Account Support
- Healthcare Customer Service
- Medical Terminology
- Benefit Explanation
- HIPAA compliance
- Customer Engagement
- EOB experience
- ICD10
Timeline
Member Services Representative
Ensemble
06.2023 - Current
Senior Member Services Representative
Neurology Consultants
08.2018 - 06.2023
Prior Authorization Specialist
UAB Huntsville Regional Medical Campus
07.2014 - 08.2018
Bachelor of Science - Communications
Alabama A&M University