Alexis Coleman

• Support on all processes related to auditing rebate invoice data, contract interpretation and help with both the root cause analysis and corrective action plan processes.

• Performing quality initiatives, including documenting processes, policies, contracts, and procedures in adherence with internal controls.

• Support for successful roll out of new initiatives, process improvements, and projects.

• Rebate Research, Claims, and Invoice teams in order to maximize resubmission opportunities, and limit client service warranty payouts arising from incorrect invoice submissions.

• Engage with and collaborate with key personnel and leaders from other functional areas, including Client Audit, Finance, Accounting, Trade, Underwriting, and Account Management.

• Train and mentor interns.

• Audit Medicare and Medicaid High Dollar claims to ensure accuracy of claims payments

• Verify that claims pay according to Contract agreement terms, DRG, and Per Diem.

• Actively works within system “QNXT” to identify gaps within the department, with a goal of eliminating Waste.

• Oversee on-going claims processes, addressing issues, debugs, implementing QA strategies to prevent reoccurring mishaps.

• Actively participates in the implementation of new data file extracts, set-up of automation, and quality assurance measures as defined by department.

• worked assignments for prior department which was to audit second level credentialing audits for six months until a new auditor is trained.

• Subject matter expert responsible for training and mentoring new hires and offshore vendors in CPD and IDX.
• Performed second level audits to ensure accuracy of first level audits in CPD, IDX EPDB, and EPC.
• Responsible for daily workflow and managing inventory control.
• Developed and completed audit reports outlining quality statistics and explaining identified errors and their causes.
• Communicated and collaborated with provider data integrity and credentialing teams to address efficiency gaps within the department- worked to create and implement improvements to ensure customer satisfaction.
• Routinely assessed, investigated, and reconciled errors outlined as rebuttals from customer service, group administration, claims processing, and non-claim processing functional areas.

• Performed provider Demographic/rate updates to ensure accuracy in CPD.
• Prescreened and processed priority provider applications in CPD within 24-hour turn-around as well as processed priority project requests from provider relations and management
• Project lead for system migration team performing data clean up and merging of duplicate providers to ensure accuracy of provider demographic information and rates in the CPD.
• Responsible for training and performing baseline audits of new hires to entire accuracy of demographic information in CPD and to identify error trends to identify additional training needs.
• Utilized conflict resolution skills for provider relations to respond to provider inquiries in regards to inaccurate payments, rate renegotiation, and demographic changes.
• Assumed full responsibility for the completion of the comprehensive testing processes for system enhancements

• Administered benefit and claims information to members, providers and group representatives
• Served as a direct contact for escalated issues for Arkansas Children’s hospital.
• Led and monitored benefit configuration and administration of new groups
• Instrumental in handling all escalated phone calls in the absence of the supervisor as well as trained, mentored, and supervised new trainees.
• Responsible for onsite visits to self-funded group to administer benefit information to employees
• Processed and adjusted escalated pharmacy claims from group contacts