Erika Carter
Gonzales,LA
Summary
Proficient healthcare administrator with significant expertise in utilization management and contracting. Track record includes supporting quality improvement efforts and performing detailed healthcare data analysis for compliance and performance enhancement. Acknowledged for strong analytical skills and ability to thrive in dynamic healthcare contexts.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Quality Improvement & Assurance Coordinator
Southeast Community Health Systems
01.2024 - 01.2025
- Supported planning and implementation of organizational performance improvement (PI) and continuous quality improvement (CQI) initiatives across clinical and administrative departments
- Assisted with quality data collection, tracking, and reporting to support organizational performance goals and regulatory requirements
- Collaborated with department leaders and medical staff to facilitate quality improvement activities and corrective action efforts
- Served as a resource to leadership and staff regarding quality standards, performance measures, and process improvement initiatives
- Participated in clinical risk management activities, including monitoring trends and supporting mitigation strategies
- Maintained documentation supporting compliance and accreditation readiness
- Assisted with preparation of reports for leadership and governing body review
Managed Care Contracting Specialist
Refresh Mental Health
01.2022 - 01.2023
- Coordinated contract processing activities, ensuring timely execution and regulatory compliance
- Maintained contract management systems supporting revenue validation and accounts receivable accuracy
- Interpreted and implemented managed care contracts
- Reconciled claims activity within EHR systems to ensure data integrity
- Supported operational improvements to increase efficiency and accuracy
Senior Care Connector
AmeriHealth Caritas Louisiana
01.2019 - 01.2022
- Compiled and analyzed performance outcome measures, outreach initiatives, and HEDIS data
- Supported data-driven decision-making for leadership and departmental meetings
- Conducted quality assurance audits and provided coaching feedback
- Trained and mentored new staff members
Utilization Management Technician
AmeriHealth Caritas Louisiana
01.2015 - 01.2019
- Processed medical authorizations in compliance with clinical and regulatory guidelines
- Supported providers with authorization requirements and documentation
- Maintained accurate records supporting utilization review workflows
Education
Bachelor of Science - Business Administration
Southern New Hampshire University
Manchester, NH05.2018
Master of Science - Healthcare Administration
Southern New Hampshire University
Manchester, NH08.2021
Skills
- Quality enhancement (QE)
- Performance improvement and data analysis Process optimization Data-driven decision making
- Healthcare compliance
- Care contract management
- Utilization oversight
- Medical billing
- Claims management
- EMR systems
- Data visualization (Tableau)
- Operational efficiency
- Team collaboration
- Staff training
- Microsoft Office proficiency Verbal and written communication Customer service excellence Relationship management
- Data visualization
- Electronic Medical Records (EMR)
- Facet analysis
- Waystar software
- CRM software platforms
- Tableau
- Azara
- eCW
- JIVA
- Avality
Certification
- SHRM Certification
- AHIMA Certification
- NCQA Certification
Additional Experience
- Capital Staffing / BCBSA / Centene Corporation
- Convergys (Customer Service, Member Services, Account Support roles)
Timeline
Quality Improvement & Assurance Coordinator
Southeast Community Health Systems
01.2024 - 01.2025
Managed Care Contracting Specialist
Refresh Mental Health
01.2022 - 01.2023
Senior Care Connector
AmeriHealth Caritas Louisiana
01.2019 - 01.2022
Utilization Management Technician
AmeriHealth Caritas Louisiana
01.2015 - 01.2019
Bachelor of Science - Business Administration
Southern New Hampshire University
Master of Science - Healthcare Administration
Southern New Hampshire University