Nicole Sarria
Thousand Oaks,CA
Summary
Proven expert in Workflow Optimization and Cross-Team Collaboration, I have significantly enhanced team efficiencies and customer service at Anthem Blue Cross. My background includes mastering Claims Processing and spearheading quality assurance improvements, leading to a notable increase in compliance rates. Skilled in EMR Systems and building robust customer relations, I excel in fast-paced, challenging environments.
Overview
23
23
years of professional experience
Work History
Medical Management Specialist II
Anthem Blue Cross
Thousand Oaks, CA
10.2021 - Current
- Train and guide staff to standardize processes and improve team efficiencies
- Oversee daily operations, monitor staff performance and provide ongoing coaching and support
- Identify and implement process improvements to enhance workflow efficiency and customer service
- Collaborate with various teams to streamline communication
- Review and process authorization requests and claims
- Review claims against medical records to determine appropriate reimbursement levels
- Assess clinical data and triage cases to utilization or case management
- Make sure policies and procedures are up to date
Medical Management Specialist
Anthem Blue Cross
Thousand Oaks, CA
07.2010 - 10.2021
- Research and resolve complex claim issues quickly and accurately
- Scheduled patient care and coordinated providers
- Facilitated the matching of patients with the appropriate providers
- Worked with teams to solve coverage issues
- Audited cases to ensure accuracy and compliance, leading to improved quality assurance scores
- Trained and mentored team members
Customer Service Representative II
Anthem Blue Cross
Thousand Oaks, CA
11.2007 - 07.2010
- Helped customers with insurance questions
- Handled a large volume of calls daily
- Built strong relationships with members and providers
- Listened to concerns and found solutions
Receptionist
Hillcrest Dental Group
Newbury Park, CA
04.2006 - 11.2007
- Scheduled appointments and assisted patients
Program Assistant
Lindora Medical
Camarillo, CA
03.2004 - 03.2006
- Helped with office tasks and patient records
Quality Control & Customer Rep.
Tony Hoffman Productions
Thousand Oaks, CA
02.2002 - 03.2004
- Checked product quality and handled customer issues
Education
Diploma -
Thousand Oaks High School
Thousand Oaks, CA06.2002
Skills
- Claims Processing
- Regulatory Compliance
- Workflow Optimization
- Cross-Team Collaboration
- Staff Training
- Customer Relations
- Microsoft Office
- Mac Productivity Tools
- Internet Research
- EMR Systems
Accomplishments
- Top Performer Awards
- Process Improvement Leader
- Strong Team Mentor
References
Available upon request.
Timeline
Medical Management Specialist II
Anthem Blue Cross
10.2021 - Current
Medical Management Specialist
Anthem Blue Cross
07.2010 - 10.2021
Customer Service Representative II
Anthem Blue Cross
11.2007 - 07.2010
Receptionist
Hillcrest Dental Group
04.2006 - 11.2007
Program Assistant
Lindora Medical
03.2004 - 03.2006
Quality Control & Customer Rep.
Tony Hoffman Productions
02.2002 - 03.2004
Diploma -
Thousand Oaks High School
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