Erika Carter

• Coordinated 50+ contract processing activities monthly, ensuring 100% timely execution and compliance with regulatory standards
• Maintained the contract management system, validating $5M in revenue and accounts receivable valuations with 99% accuracy
• Interpreted and implemented managed care contracts, achieving a 98% accuracy rate in contract execution
• Reconciled 200+ processed claims to the EHR daily, ensuring 100% data integrity
• Managed data for 10 new acquisitions, enhancing operational efficiency and reducing processing time by 25%
• Optimized the contract management system, improving claims reconciliation efficiency by 30% and increasing accuracy in accounts receivable valuations by 20%

• Managed the distribution of daily work assignments, including worklist activities and fax queue management, ensuring timely completion and adherence to operational standards
• Compiled and analyzed reports for Performance Outcome Measures campaigns, manual outreach initiatives, and Healthcare Effectiveness Data and Information Set collection, contributing to data-driven decision-making for monthly departmental meetings
• Oversaw workforce management by adjusting schedules for optimal team performance and maintaining accurate records of attendance, paid time off, and leave requests
• Conducted quality assurance by auditing team member calls, providing constructive feedback, and coaching, enhancing customer service standards and team competency

• Processed medical authorizations efficiently, ensuring timely and accurate decisions for those not requiring clinical review
• Delivered comprehensive support to healthcare providers, addressing inquiries, and facilitating the authorization submission process.
• Enhanced team capabilities by training new staff members and participating in the selection process for prospective employees.

• Advised 200+ members on health plans and coverage, addressing inquiries and providing clear information with a 95% satisfaction rate
• Educated 150+ members on benefits and coverage, enhancing their understanding and increasing member satisfaction by 20%
• Assisted 50+ providers with member eligibility and benefits, ensuring accurate authorization processes with a 98% accuracy rate
• Offered claims assistance, resolving 100+ issues for both members and providers efficiently, achieving a 90% resolution rate

• Advised members on insurance health plans across multiple states, ensuring accurate information
• Educated members on health plan benefits and coverage, enhancing understanding and satisfaction
• Assisted providers with member eligibility and benefits, facilitating smooth operations
• Resolved claims issues for both members and providers, improving service efficiency
• Updated member contact information, maintaining accurate records and communication

• Resolved customer inquiries regarding mobile phone billing, ensuring clarity and satisfaction with services provided.
• Conducted training sessions for both new hires and existing staff on product updates and service offerings, facilitating consistent knowledge across the team.
• Supported the successful implementation of new business lines and pilot programs, contributing to seamless rollouts and enhanced service capabilities.

Collaborated with clinical and administrative teams to drive performance improvement (PI) and continuous quality improvement (CQI) initiatives, ensuring adherence to best practices.

Conducted comprehensive analysis and tracking of healthcare quality data to uphold compliance standards and promote performance enhancement strategies.

Facilitated collaboration with department leaders and clinical staff to identify quality gaps and execute corrective action plans.

Organized and updated documentation to support compliance with regulatory audits and prepare for accreditation evaluations.

Generated detailed quality performance reports and dashboards, emphasizing key metrics for leadership evaluation.

Engaged in risk management activities and tracked performance trends to inform effective mitigation strategies.