Raquel Wright Email & Phone Number

Greater Chicago Area

Lisle, IL

• Oversee the configuration operation functions for implementations.
• Oversee team in the integration of legacy clients to Payer Compass editing and pricing software.
• Collaborate with Market Operations in reviewing current internal processes to remove barriers and gaps; to develop effective and efficient internal processes.
• Manage and identify process improvement opportunities in the configuration process to assure timely, accurate implementation of Clients’ products.
• Collaborate with internal and external parties on defining, documenting and configuring updates, corrections, new rules and regulations.
• Work with internal and external business leads on finding and solutioning for gaps and missed requirements in pricing and editing setup.

Greater Chicago Area

Collaborate with the Client and internal Teams on interpreting the client’s business requirements, the impact of the new solution(s) on business processes and translating that into detailed configuration requirements. Facilitates system/configuration design sessions. Validates system/configuration and documents issues. Creates mapping documents and handles.

Oak Brook, IL

• Coordinate with Senior Leadership in understanding different process plans, business processes and functionality in depth
• Work closely with the State of Illinois Department of Healthcare and Family Services’ (HFS) Encounter Team to understand expectations of the encounter process
• Research and resolve HFS edits received on outbound dental, institutional, pharmacy and professional Encounter files
• Collection of the data related to the business process
• Provide analysis and document business process using identified requirements
• Provide assistance in the project planning

Naperville, Illinois

• Provides estimates on the level of effort needed for new developments.
• Create and execute test cases and procedures utilizing business requirements and conceptual design documents.
• Validate test results, report and track defects throughout the project life cycle.
• Support Clients during migration, user acceptance testing, smoke testing and production issues.
• Interact with Claims, Appeals and Reimbursement Teams, as well as other IT functional areas to ensure the successful implementation of the company’s initiatives.

• Analyze system set up and process flows
• Conduct root cause, research and resolution on client disputes and retrospective audits
• Test, approve and implement system enhancements
• Implemented the Quality Reviewer auditing program
• Develop departmental policies and procedures and identified areas for process improvements
• Handled Team Lead functions within the Claims department

Naperville, Illinois

• Interpreted the network provider contracts and build these contracted rates in the Networx Admin system
• Adhered to the Company and Client specific policies and procedures in the set up of the contracted/negotiated rates for each facility contract
• Responsible for the overall effectiveness of assigned network’s contract

Naperville, Illinois

• Established and executed Claims Repricer auditing and training functions
• Developed training material and determine the most effective program for new employees
• Identified additional training needs for employees based on audit results and quality standards
• Resolve claim questions and customer appeals
• Produced monthly reports on quality standards

Naperville, Illinois

• Accurately repriced claims by reviewing the provider contracts and fee schedule database to determine the correct allowable
• Reviewed and researched claim processing issues from internal staff
• Pended claims requiring additional information
• Exceeded quality, accuracy and turnaround standards for claim repricing