Erica Cook
@ericacook
Dedicated healthcare professional with extensive claims processing experience.
United StatesWhat I'm looking for
With a strong background in healthcare claims processing, I have developed a comprehensive understanding of the intricacies involved in managing provider inquiries and ensuring compliance with industry regulations. My experience spans several roles, including Provider Service Representative and Provider Resolution Analyst, where I have honed my skills in claims analysis, problem resolution, and team collaboration.
Throughout my career, I have been recognized for my ability to investigate and resolve complex claims issues efficiently. At Amerihealth Caritas, I served as a Subject Matter Expert, conducting training sessions and cross-training staff to enhance operational efficiency. My commitment to quality and timeliness has consistently contributed to improved service delivery and member satisfaction.
I am currently pursuing an Associate Degree in Nursing, which complements my extensive experience in the healthcare sector. I am passionate about leveraging my skills and knowledge to contribute positively to patient care and organizational success.
Experience
Work history, roles, and key accomplishments
Provider Service Representative
Amerihealth Caritas
Nov 2022 - Present (2 years 8 months)
Suspended claims requiring additional information and initiated actions to obtain necessary details. Monitored outstanding inquiries and collaborated with management to resolve non-compliance issues.
Intake Care Senior Representative
Cigna
Jun 2022 - Nov 2022 (5 months)
Collected, documented, tracked, and scheduled various program components, ensuring transactions adhered to guidelines and timelines. Assisted clinical staff with paperwork and documentation, and conducted outreach to obtain medical records.
Provider Resolution Analyst II
Horizon NJ Health
Jun 2018 - Nov 2021 (3 years 5 months)
Investigated and resolved claims issues, including incorrectly paid claims, by analyzing systems and processes. Researched and adjusted post-payment claims in accordance with plan contracts and policies.
Provider Service Representative
Amerihealth Caritas
Sep 2015 - Jun 2018 (2 years 9 months)
Suspended claims needing additional information and initiated actions to acquire required details. Monitored outstanding inquiries and collaborated with management to identify and resolve areas of non-compliance.
Member Service Representative/Claims Analyst
Independence Blue Cross
Dec 2014 - Sep 2015 (9 months)
Identified and assessed members' needs to achieve satisfaction, adhering to First Call Resolution goals. Documented interactions to track contact reasons and trending issues in a timely manner.
Provider Service Representative
Kennedy Health Alliance
Mar 2013 - Mar 2014 (1 year)
Accurately entered and updated patient demographics, building rapport with current and new patients. Verified patient eligibility, financial status, and assigned correct pay types.
Education
Degrees, certifications, and relevant coursework
Camden Community College
Associate Degree, Nursing
Currently pursuing an Associate Degree in Nursing, gaining foundational knowledge and practical skills in patient care and healthcare systems. The program focuses on developing critical thinking and clinical competencies essential for nursing practice.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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