PATRICIA ERICKSON
Saint Mary’s,GA
Summary
Experienced Licensed Practical Nurse with a solid background in administrative nursing, boasting over a decade of expertise. Efficiently manages patient care, coordinates schedules, and maintains precise medical records even when working remotely. Thrives in collaborative team environments, known for dependability and adaptability to dynamic settings. Highly skilled in patient assessment and electronic health records, consistently delivering reliable results. Demonstrates a keen ability to adapt to evolving healthcare needs and processes while maintaining diligent attention to detail. Exceptional communication skills round out a comprehensive skill set.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Administrative Nurse
Florida Blue
01.2018 - 01.2025
- Company Overview: Blue Cross and Blue Shield of Florida
- Post Service medical review nurse/ Prior authorizations
- Utilization review
- Interqual and Florida Blue medical coverage guidelines
- Update provider database
- Prepare claims for physician review and response letters
- Chart review for the pricing of unlisted codes
- Played an instrumental role in achieving accreditation status by adhering to rigorous industry standards
- Maintains NCQA standards
- Maintained 100% accuracy rating for 28+ months
- Able to navigate multiple software programs and work independently while meeting production standards
- Excellent written and verbal skills
- Blue Cross and Blue Shield of Florida
PRN Licensed Practical Nurse
Southeast Georgia Health System
04.2011 - 06.2021
- Management of thirty (30) assigned patients by adhering to established protocols for medication administration, treatments, infection control and care plans yielding timely and precise delivery of care
- Monitored and aided healthcare staff to deliver superior patient care, facilitating continuous improvement in care standards by providing guidance and support to team members
- Implement individual care plans for patients with chronic conditions
- Organized daily administrative tasks including scheduling, transportation, nursing assignments, and patient care coordination by implementing effective organizational strategies
Clinical Appeals Specialist
Parallon Business Solutions
08.2012 - 01.2016
- Achieved significant appeal reimbursements of over $200K on a regular monthly basis with Parallon, demonstrating strong track record in securing substantial financial recoveries
- Tracked denied insurance claims and communicated with multiple insurance providers to resolve issues, successfully reducing claim denial rates
- Augmented claims processing through Microsoft Office applications, Artiva, Continuity, Midas, Optum Cloud, and other electronic appeals programs by leveraging InterQual certification, HEDIS, and ICD-10
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
Cardiology Triage
UF Jacksonville Physicians
08.2008 - 08.2012
- Responds to patient questions and concerns in person or telephone
- Evaluate needs and respond accordingly: appointments, medication management and refills
- Obtain prior authorization for procedures, medication and referrals as needed
- Created database of physicians requested labs and tests for patients and follow up to check for completion
- Assisted patients who required financial assistance to obtain medications
- Assist discharges with transition of care services Referrals, appointments, DME, home health
- Worked effectively in fast-paced environments
- Managed approximately 40 incoming calls, emails and faxes per day for a team of 6 Cardiologist.
Education
Associate of Science - Business Administration
Albany Business College
Albany, NYVocational Diploma - Practical Nursing
Hudson Valley Community College
Troy, NYSkills
- Electronic health records
- Interqual
- HIPAA compliance
- Care Plans
- Ability to work under pressure
- Time management
- Nursing management
- Documentation accuracy
Certification
- Interqual
- Georgia Licensed Practical Nurse 072299
- Nurse Licensure Compact (NLC)
- NYS Licensed Practical Nurse 232339
- CPR Certification
Timeline
Administrative Nurse
Florida Blue
01.2018 - 01.2025
Clinical Appeals Specialist
Parallon Business Solutions
08.2012 - 01.2016
PRN Licensed Practical Nurse
Southeast Georgia Health System
04.2011 - 06.2021
Cardiology Triage
UF Jacksonville Physicians
08.2008 - 08.2012
Associate of Science - Business Administration
Albany Business College
Vocational Diploma - Practical Nursing
Hudson Valley Community College
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