Patricia Weaver

· Evaluated customer service interactions to ensure compliance with organizational standards while providing constructive feedback to improve performance.

· Collaborated with cross-functional teams to enhance operational efficiency.

· Conducted training sessions for new hires to explain quality standards and expectations.

· Constructed multiple reports to provide internal leadership teams and external clients with productivity status.

• Investigated second level appeals involving claims that denied due to coding related issues.
• Applied relevant coding guidelines to thoroughly analyze each issue and determine to overturn or uphold the denials based on established best practices.
• Consulted healthcare providers through phone and e-mail to advise of final determination and provided coaching on correct coding initiatives.
• Fielded code editing questions from providers and Humana market offices related to hospital, ancillary and physician claims.

• Designed templates used to answer frequently asked questions which resulted in a significant drop in email inquiries.
• Educated healthcare providers on the registration and adoption of Humana's electronic tools including Humana.com and Availity.com, Electronic Claims Submission (ESC), and Electronic Remittance Advice/ Electronic Funds transfer (ERA/EFT).
• Analyzed information to determine root causes and resolve customer inquiries.
• Facilitated the training and development of new E-Business associates.

• Succeeded in transitioning departments processes in time for the American Reinvestment and Recovery Act (ARRA) of 2009.
• Processed pends, paper and non-standard applications per federal and state mandates, Including COBRA, Conversion and State Continuation Items, and court-related documents.
• Performed root cause analysis and resolution of internal and external high profile inquiries.
• Oversaw mailbox and partnered with representative from third party administrator to review and resolve escalated COBRA related issues.

• Consistently exceeded all productions and quality standards of 95% or higher.
• Resolved inbound customer inquiries regarding eligibility, benefits transactions, balances, and claims for Healthcare Spending Accounts (PCA, FSA and HSA) and Dependent Care Accounts.