Tricia Shields

• Demonstrate flexibility in a changing environment
• Able to work with all levels of management to accomplish the goals of the department
• Oversee and coordinate department activities
• Identify and champion process improvement within departments
• Participate on committees and lead departmental workgroups
• Provide new hire with training, assist with the on-boarding process, develop and mentor where needed
• Oversee, manage and support staff with work assignments, special project, inventory management
• Review team quality and production
• Coordinate training, shift rotations, time management and scheduling of staff
• Manage long term support and services to ensure all regulator and compliance requirements are met
• Partner with external stakeholders which may include presentations and business case preparations
• Perform other relevant duties as assigned by management
• Monitoring timeliness and accuracy within the team
• Review and respond to quality measurement individual errors
• Served as a mentor/coach cross divisional.
• Coached team members in techniques necessary to complete job tasks.
• Developed monthly and daily production output plans to deliver on customer service and financial metrics.
• Conducted training and mentored team members to promote productivity and commitment to friendly service.
• Held weekly team meetings to inform team members on company news and updates.
• Monitored time and attendance, enforcing compliance with company procedures relating to absenteeism.
• Assisted in recruitment of new team members, hiring highest qualified to build team of top performers.
• Educated staff on organizational mission and goals to help employees achieve success.
• Helped meet changing demands by recommending improvements to business systems or procedures.
• Provided reporting for forecast analysis and ad-hoc reporting in support of decision-making.

Primary analyst to The Valley Hospital, functions in this role is to ensure that the hospital's account receivables are kept below their box scores

• Prevented delays and claim denials by correcting information prior to submission.
• Preparation of spreadsheets, responding to written inquires and correspondence
• Partnered with internal areas such as State Health Benefits (SHBP) and Federal Employee Program (FEP) Contracting, Healthcare Management, Finance, Enrollment, Business Team Units and Medical Policy
• Handling other tasks to aid in the reduction and the account reconciliation process
• Responsible for rolling up monthly spreadsheets and summary presentations for quarterly meetings with the hospital account executives
• Responding efficiently and accurately to callers, explaining possible solutions, and ensuring that clients feel supported and valued
• Helped minimize escalations by reaching out to clients in advance of expected problems.
• Coordinated with contracting department to resolve payer issues.
• Taking part in training and other learning opportunities to expand knowledge of company and position
• Adhering to all company policies and procedures.
• Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
• Followed up on denied and unpaid claims to resolve problems and obtain payments.
• Compiled department-specific reports to help senior managers identify trends and improve progress.
• Managed book of business totaling ($250-300K) in accounts receivable, applying insurance expertise and exemplary customer service.
• Checked documentation for accuracy and validity on updated systems.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Verified client information by analyzing existing evidence on file.
• Posted payments to accounts and maintained records.
• Calculated adjustments, premiums and refunds.
• Assured timely verification of insurance benefits prior to patient procedures or appointments.
• Determined appropriateness of payers to protect organization and minimize risk.

• Answered inquires regarding claim status information, membership eligibility
• Update membership file validate network status, contractual agreements, referrals and benefit determination
• Investigated pricing requests on claims for over 75 third party networks for various bank clearances
• Partnered with and responded to an average of 70-90 telephone inquires daily, dealing primarily with members, providers plan administrators, partnered with sales team to validate accuracy with membership files.

• Handled customer inquiries and suggestions courteously and professionally.
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
• Answered constant flow of customer calls with minimal wait times.
• Answered customer telephone calls promptly to avoid on-hold wait times.
• Tracked customer service cases and updated service software with customer information.
• Analyzed customer service trends to discover areas of opportunity and provide feedback to management.
• Followed up with customers about resolved issues to maintain high standards of customer service.
• Bolstered customer retention by creating and offering unique discount options and inspiring interest in new product lines.