Patrice Edwards Email and Phone Number

Design and deliver comprehensive training programs for new hires and existing team members, focusing on claims processing procedures, company policies, and industry regulations.Develop training materials, including manuals, presentations, and e-learning modules, to ensure consistent and effective learning experiences.Assess trainee performance through evaluations, feedback sessions, and testing, identifying areas for improvement and tailoring training approaches accordingly.Stay updated on changes in healthcare regulations and claims processing best practices. continuously incorporating new information into training programs.Lead workshops and refresher courses to ensure all team members remain compliant with the latest standards and practices.

Supervised a team of claims analysts, overseeing daily operations and ensuring the accurate and timely processing of high-volume claims.Managed performance metrics and conducted regular performance reviews, leading to a 15% improvement in team efficiency. Implemented process improvements that reduced claim processing time by 20%, enhancing overall productivity.Provided mentorship and training to new hires and existing team members, fostering a collaborative and skilled work environment.Led initiatives to enhance team knowledge of evolving industry regulations, resulting in a 10% reduction in compliance-related errors.

Led a team of claims analysts, ensuring timely and accurate processing of medical claims in alignment with company policies and industry regulations.Monitored and evaluated team performance, providing coaching and feedback to improve productivity and accuracy. Developed and implemented training programs to enhance team members' skills and knowledge of claims processing procedures.Collaborated with management to establish performance goals and objectives, successfully meeting or exceeding departmental targets.Analyzed claims processing workflows to identify inefficiencies and proposed solutions that streamlined operations and reduced processing times.

Processed and adjudicated medical claims for accuracy, compliance, and appropriate reimbursement within a fast-past envirement.Reviewed claims for compliance with federal, state and company policies, ensuring timely and accurate payments.Collaborated with cross-functional teams to resolve discrepancies and expedite claims processing.Communicated with healthcare providers and members to resolve complex claim issues and provide clarification on claim statuses.Achieved a consistent record of meeting or exceeding performance metrics for claims processing time and accuracy.

Gather and analyze information for ongoing operations of the organization and initiate appropriate action when follow-up is indicated.- Develop written reports and present information clearly, concisely, and effectively.- Perform an array of benefit adjustments: simple, closed, denied and complex daily.- Ensure member satisfaction by maintaining accurate documentation in ORS.- Provide members with status updates regarding claim appeals and pre-existing clauses. - Responsible for member claim case follow-up as needed for resolution and closing issues.- Adhere to Quality guidelines, HIPPA Act and procedures.- Review benefit claims for errors, proper processing, and payments.- Data enter appropriate diagnoses coding, medical coding and or adjustments to process and review for errors.- Determine appropriate execution of each case by using critical decision making and product knowledge.- Resolve claims edits and suspended claims- Route escalated member claims and or inquiries to internal departments for review to determine eligibility and accuracy.- Cross Reference and research all member claims and complex issues to identify discrepancies.- Provide direct customer service to members and Providers for Quality Assurance.- Authorize gap exceptions for members with PPO benefits to identify local providers.- Adjudicate claims and adjustments- Assisted on the Supervisor line with escalated issues.

Gather and analyze information for ongoing operations of the organization and initiate appropriate action when follow-up is indicated.- Develop written reports and present information clearly, concisely, and effectively.- Perform an array of benefit adjustments: simple, closed, denied and complex daily.- Ensure member satisfaction by maintaining accurate documentation in ORS.- Provide members with status updates regarding claim appeals and pre-existing clauses. - Responsible for member claim case follow-up as needed for resolution and closing issues.- Adhere to Quality guidelines, HIPPA Act and procedures.- Review benefit claims for errors, proper processing, and payments.- Data enter appropriate diagnoses coding, medical coding and or adjustments to process and review for errors.- Determine appropriate execution of each case by using critical decision making and product knowledge.- Resolve claims edits and suspended claims- Route escalated member claims and or inquiries to internal departments for review to determine eligibility and accuracy.- Cross Reference and research all member claims and complex issues to identify discrepancies.- Provide direct customer service to members and Providers for Quality Assurance.- Authorize gap exceptions for members with PPO benefits to identify local providers.- Adjudicate claims and adjustments- Assisted on the Supervisor line with escalated issues.