Lindsey Rickman
Pacificsource Health Plans
Cottage Grove
1
Certification
13
years of professional experience
Health insurance professional with more than a decade of experience and growth. I am passionate about member centered care and making sure that member's overcome barriers and achieve their best possible health outcomes. I am skilled in resolving complex case management and medical billing and claims issues. I have strong experience in helping member's navigate a complex medical system at all levels.
Work History
Member Support Specialist
4 Years 2 Months- Promoted member‑centered care and advocated for individuals navigating complex healthcare systems.
- Collaborated with case managers to develop and implement individualized care goals and navigation plans.
- Educated members on benefit structures, insurance enrollment, specialty care access, and social service programs.
- Supported provider and community teams by aligning services and facilitating member‑focused coordination meetings.
- Assisted members with referrals, appointment scheduling, and transportation arrangements to ensure access to care.
- Provided non‑clinical assistance during care transitions and across phases of care.
- Conducted outreach using motivational interviewing to increase member engagement and optimize benefit utilization.
- Identified member needs and connected individuals with community resources to address social determinants of health.
- Screened members for case management and resource needs using claims data, HIE, PreManage, EMR, referrals, and outreach.
- Reviewed case management referrals and connected members to appropriate levels of care.
- Supported team leads with workflow improvements and training of staff.
- Partnered with community organizations to develop events and initiatives enhancing health‑related resources.
- Served as a resource for the Health Related Services program and assisted with related procedures and workflows.
Utilization Management Coordinator
3 Years 8 Months- Coordinated utilization review processes to ensure compliance with healthcare regulations.
- Analyzed patient data to identify opportunities for improved care management strategies.
- Facilitated multidisciplinary team meetings to streamline care coordination efforts.
- Developed training materials for new staff on utilization management protocols.
- Mentored junior staff on best practices in utilization management and documentation standards.
- Reduced hospital readmission rates through thorough assessment of patient needs, developing appropriate post-discharge plans.
- Ensured regulatory compliance by staying updated on industry guidelines and applying them to daily tasks and assessments.
- Supported cost-effective use of services by ensuring that authorization requests met clinical review criteria before approving them.
Customer Service Representative
4 Years 8 Months- Resolved customer inquiries through phone and email, ensuring timely and accurate responses.
- Collaborated with cross-functional teams to address complex customer issues effectively.
- Implemented process improvements that enhanced service delivery and reduced resolution times.
- Trained new team members on customer service protocols and best practices.
- Mentored junior representatives, fostering a culture of continuous improvement and high-quality service delivery.
- 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.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Assisted in processing claims and ensuring accuracy of submitted documentation.
- Resolved customer inquiries regarding health plan coverage and benefits efficiently.
- Educated members on policy details, helping to clarify complex information.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
Education
Associate of Applied Science - Health Information Management
- Relevant Coursework: Medical Billing and Coding (ICD-10 and HSPCS), Medical Transcription, Health Insurance Laws and Policies, Medical Terminology.
Skills
Epic EMR Super User
Adaptability
Motivational Interviewing
Call escalations
Medical Billing and Claims
SDOH REsources
Microsoft Office
EMR Systems
Dynamo
Onbase
Facets and more.
Mentoring and Training
Customer satisfaction
Certification
- Certified Traditional Health Worker, Oregon Health Authority - Current
Timeline
Member Support Specialist
Pacificsource Health Plans
05.2022 - 07.2026Read More
Utilization Management Coordinator
Pacificsource Health Plans
09.2018 - 05.2022Read More
Customer Service Representative
Pacificsource Health Plans
01.2014 - 09.2018Read More
Lane Community College
Associate of Applied Science from Health Information Management
Read More