Candice Nance

Led high-volume medical claims adjudication processes to enhance operational efficiency Directed claims analysis and resolution efforts to minimize errors and expedite payments Interpreted health insurance policies and plans to ensure compliance and clarity Oversaw adherence to regulatory compliance, including CMS guidelines and HIPAA regulations Managed validation of CPT, ICD-10, and HCPCS coding to uphold accuracy standards Supervised benefits and eligibility verification processes to optimize service delivery Coordinated benefits effectively to improve claims processing timelines Resolved claims discrepancies and implemented adjustments to enhance accuracy Provided strategic support for appeals and denials review processes Championed quality assurance and audit support initiatives to maintain high standards Ensured documentation accuracy and implemented detailed recordkeeping practices Drove process improvement and workflow optimization initiatives to enhance productivity Cultivated strong provider and member relations to foster trust and satisfaction Collaborated with cross-functional teams, including legal, QA, and operations, to achieve common goals Streamlined data entry and claims systems navigation for improved efficiency Leveraged Microsoft Excel for comprehensive data tracking and reporting Developed documentation and formatted materials using Microsoft Word Maintained a typing speed of 45 wpm to support efficient communication