Erika Buchholz

COMMON GROUND HEALTHCARE

10.2014 - Current

Processing knowledge for all types of claims, as well as assisting on creating documentation for new processes, process improvements, and helped to create or update policies and procedures.
Escalation point for claims resolution for the member services as well as various other departments.
Help to find trends in provider issues and communicate those to the proper department for resolution.
Answer questions for the claims team. Part of this was being involved in the mentoring program, which included being the point person for questions related to the system, pricing and processes.
Provide constructive feedback when SLAs are not met and helping to resolve the roadblocks to get the team member to meeting those in a short period of time.
Assisted with testing in the UAT environment to assure plan/product changes were correct for the upcoming plan year. This also included validation in the production environment.
Primary person to handle the check run. This includes kicking off the job in Aldera as well as downloading the reports to send to the Finance department as well as other members of the leadership team. Also communicated any off cycle check run dates to the various stakeholders.
Handle workflow management, including distributing inventory and coordinating with leadership to adjust for shifting priorities.
Company projects/new initiatives - worked to operationalize new processes so they would be ready for the rest of the team to work

Summary