PATRICE EDWARDS
Charlotte,NC
Summary
Dedicated customer service professional with experience supporting TRICARE, Community Care Network, Elderly Housing Operations, and healthcare service coordination. Experienced in Insurance, explanation of benefits, prior authorization review and submission, insurance verification, case management, resident advocacy, provider relations, community resource navigation, and patient support.
Overview
17
17
years of professional experience
Work History
Customer Service Representative / Prior Authorization Reviewer
TRICARE Alliance
, North Carolina
03.2025 - Current
- Review medical and behavioral health prior authorization requests.
- Supported veterans, active-duty service members, retirees, beneficiaries, and providers with inquiries regarding benefits, claims, and authorizations, ensuring clarity and timely responses.
- Verify insurance eligibility, benefits, and coverage information.
- Assisted customers with inquiries about health benefits and services, enhancing understanding and access to necessary resources.
- Maintain detailed documentation within CRM systems while adhering to HIPAA standards.
- Processed claims and ensured accurate documentation in the system.
- Coordinated communication between clients and healthcare providers to facilitate resolution of issues and improve service delivery.
- Worked remotely to assist clients with inquiries
Intake Specialist / Prior Authorization Coordinator
Cohere Health
, North Carolina
08.2021 - 12.2024
- Managed high-volume healthcare calls, ensuring prompt and accurate service delivery to enhance patient satisfaction.
- Reviewed and processed prior authorization requests, facilitating timely access to medical services for patients.
- Conducted initial assessments to determine patient needs and eligibility.
- Gathered and verified patient information using company databases and tools.
- Worked remotely to support healthcare operations.
- Managed high-volume healthcare calls while delivering exceptional customer service.
- Gathered and verified patient information in company databases, supporting efficient processing of authorization requests.
- Remote
Call Center Representative
Humana
, North Carolina
09.2020 - 08.2021
- Supported members with insurance claims, eligibility verification, billing concerns, and benefit inquiries, ensuring accurate resolution and member satisfaction.
- Protected confidential patient information while achieving compliance with quality standards.
- Worked remotely to support team operations.
Service Coordinator
Elderly Housing Operations Corporation
Washington, DC
07.2009 - 11.2019
- Coordinated resident services and support for elderly housing community.
- Conducted comprehensive case management services and ongoing resident needs assessments to evaluate Activities of Daily Living (ADLs).
- Organized health screenings, wellness programs, educational workshops, and legal and medical seminars to enhance resident well-being and knowledge.
- Advocated for residents and acted as a liaison between residents, families, healthcare providers, and caregivers.
- Facilitated community gatherings and support programs that fostered connections among residents, reducing isolation and promoting social engagement.
- Coordinated essential services for residents in elderly housing community. and support for elderly housing community.
- Managed scheduling for maintenance and repair requests submitted by residents. of maintenance and repair requests for residents.
- Assisted families with inquiries and provided resources for elder care.
Education
Bennett College
Greensboro, NCAmerican InterContinental University
Schaumburg, ILSkills
- Prior authorization
- Insurance verification
- Claims processing
- Authorization processing
- Patient database management
- HIPAA compliance
- Insurance plan assessment
- Customer relationship management
- Problem resolution
- Effective communication
- Attention to detail
- Conflict resolution
- Time management
- Customer service
Timeline
Customer Service Representative / Prior Authorization Reviewer
TRICARE Alliance
03.2025 - Current
Intake Specialist / Prior Authorization Coordinator
Cohere Health
08.2021 - 12.2024
Call Center Representative
Humana
09.2020 - 08.2021
Service Coordinator
Elderly Housing Operations Corporation
07.2009 - 11.2019
Bennett College
American InterContinental University