Erika Shuford
Jacksonville,FL
Summary
Detailed-oriented individual with a strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. At Ascension St. Vincent's, my primary role has been managing complex patient referral processes efficiently and accurately. Utilizes medical terminology and patient care skills to ensure timely and effective communication between healthcare providers. Knowledge of healthcare coordination and referral management protocols that drive patient satisfaction and operational efficiency.
Overview
27
27
years of professional experience
Work History
Financial Representative
UF Health Shands Hospital
08.2024 - Current
- Reports directly to the Departmental Manager/Supervisor. Completes the admission/registration process and other admission finance functions. Serves as liaison between patients, nurses, physicians and others. Responsible for handling walk-in patients and incoming telephone calls from customers seeking assistance with matters involving the patient accounting function. This position must be knowledgeable of admitting, billing and collection functions and be able to resolve any outstanding issues without involving other staff members. Provides excellent customer service.
- Met with customers to assess needs, financial status, and eligibility.
- Built strong relationships with clients through transparent communication and trust-building activities.
Patient Referral Coordinator
Ascension St. Vincent's
04.2016 - 04.2024
- Served as a liaison between patients, providers, and insurance companies during the referral process, addressing any concerns or questions that arose along the way.
- Enhanced patient experience by coordinating timely and efficient referrals to specialists.
- Streamlined referral processes for improved patient satisfaction and reduced wait times.
- Trained new employees on referral coordination procedures, ensuring consistent quality of service.
- Developed constructive working relationships with local healthcare facilities which resulted in seamless patient transfers.
- Maintained strong relationships with referring physicians, resulting in increased referral volume.
- Created a centralized database for all incoming referrals, streamlining communication between departments.
- Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
- Provided excellent customer service to patients and medical staff.
- Verified patient insurance eligibility and entered patient information into system.
- Worked with patients to ascertain issues and make referrals to appropriate specialists.
- Participated in team meetings where best practices were shared leading to strengthened internal processes.
- Supported positive outcomes for patients by monitoring their transition from primary care providers to specialty care services.
Customer Service Representative
Nemours Children's Clinic
03.2004 - 04.2016
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Trained new Customer Service Representatives on company policies, procedures, and best practices.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Sought ways to improve processes and services provided.
- Adapted quickly to new technologies introduced into the call center environment, utilizing tools effectively during customer interactions.
- Demonstrated excellent multitasking abilities by simultaneously handling multiple tasks such as navigating systems, taking notes on calls, and answering inquiries from clients.
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
Insurance Customer Service Representative
Aetna Inc
03.1999 - 03.2004
- Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
- Processed policy updates and changes accurately, ensuring client needs were met in a timely manner.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Responded to customer requests for products, services, and company information.
- Assisted clients in filing claims, coordinating with adjusters to expedite the process and secure fair settlements.
- Enhanced customer satisfaction by addressing and resolving insurance-related inquiries and concerns.
- Liaised with insurance carriers to resolve billing errors and discrepancies.
- Utilized company software to track customer interactions efficiently, ensuring proper documentation of all transactions.
- Coordinated with other departments to streamline customer service procedures, enhancing overall service delivery.
- Contributed to team meetings with insightful feedback, aiming for continuous improvement in customer service.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Claims Processor
Humana,Inc
02.1998 - 10.1999
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Followed up with customers on unresolved issues.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
- Reduced claim processing time for faster customer service and improved satisfaction rates.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Developed strong relationships with healthcare providers and insurance agents to facilitate seamless communication during the claims process.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
- Streamlined communication channels between departments for more efficient handling of claim-related inquiries from both customers and colleagues alike.
- Contributed to the development and implementation of new procedures, policies, or guidelines that improved claim processing efficiency across the organization.
- Achieved high levels of customer satisfaction, handling each claim with professionalism and care.
Education
High School Diploma -
William M Raines High School
Jacksonville, FL06-1990
Skills
- Appointment scheduling
- Payment processing
- Customer service
- Service referrals
- Multitasking Abilities
- Microsoft office
- Computer skills
- Excellent communication
- Time management
- Claims processing
- EPIC
- EMR
- Medical terminology
- Billing and coding knowledge
Accomplishments
Achieving 100% QA customer service calls
Accolades with creating a training manual to training new hires
Medical terminology courses
achieving 100% customer service QA calls
I was able to achieve these goals by following the QA guidelines step by step that was provided by the QA representatives which in turn help me to achieve these goals that was expected of me to achieve 100% QA.
Timeline
Financial Representative
UF Health Shands Hospital
08.2024 - Current
Patient Referral Coordinator
Ascension St. Vincent's
04.2016 - 04.2024
Customer Service Representative
Nemours Children's Clinic
03.2004 - 04.2016
Insurance Customer Service Representative
Aetna Inc
03.1999 - 03.2004
Claims Processor
Humana,Inc
02.1998 - 10.1999
High School Diploma -
William M Raines High School
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