Erica Connors
Surprise
Summary
Claims analyst with eight years of experience specializing in Medicaid claims processing and analysis. Strong problem-solving skills and effective communication foster operational improvements and compliance adherence. Demonstrated success in claims analysis and quality assurance, contributing to increased accuracy and payment integrity.
Overview
14
14
years of professional experience
Work History
Claims Analyst
Catalyst/Aetna
Surprise
11.2021 - Current
- Resolved claim issues by conducting detailed investigations using the QNXT processing system.
- Accurately calculated claim pricing and reimbursement through various methodologies.
- Analyzed Aetna Medicaid claims, coordinating benefits and handling resubmissions.
- Identified root causes of discrepancies, working collaboratively to implement corrections.
- Ensured adherence by reviewing claims against Medicaid policies and contractual standards.
- Aided special projects targeting improved claims accuracy, payment integrity, and operations.
- Monitored workflows by utilizing Claims Central IOP Viewer for documentation review.
- Sustained high productivity and quality within a dynamic claims processing setting.
Co-Owner/Administrative Manager
White Tanks Mechanical LLC
Surprise
08.2018 - 07.2021
- Job responsibilities: bookkeeping, marketing, and promoting customer service, assisting with plumbing tasks, conducting material audits, and managing daily paperwork.
Claims Reviewer
TriWest Healthcare Alliance
Phoenix
01.2015 - 01.2018
- Reviewed claims for Department of Veterans Affairs PC3 and Choice programs.
Conducted 1% audits on claims processed by WPS.
Addressed congressional issues related to veteran billing and claims.
Resolved processing and accounts receivable review discrepancies.
Medical Claims Processor
United Healthcare
Phoenix
10.2012 - 10.2013
- Handled Medicaid claims processing on Diamond platform for four states, focusing on benefit coordination and denial resolutions.
Identified and corrected pricing errors in a rapidly changing production setting.
Employed standard operating procedures to ensure adherence to updated policies and guidelines.
Education
Some College (No Degree) - Nutrition
Central New Mexico Community College
Albuquerque, NMSkills
- Claims analysis
- Claims review
- Reimbursement analysis
- Policy compliance
- Medicaid regulations
- Quality assurance
- Dispute tracking
- Problem solving
- Critical thinking
- Attention to detail
- Time management
- Multitasking ability
- Effective communication
- Team collaboration
- Professional demeanor
- Self-motivation
Timeline
Claims Analyst
Catalyst/Aetna
11.2021 - Current
Co-Owner/Administrative Manager
White Tanks Mechanical LLC
08.2018 - 07.2021
Claims Reviewer
TriWest Healthcare Alliance
01.2015 - 01.2018
Medical Claims Processor
United Healthcare
10.2012 - 10.2013
Some College (No Degree) - Nutrition
Central New Mexico Community College