Renee Edwards

• Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
• Improved the appeals success rate by researching legal precedents and staying up-to-date with current industry regulations and guidelines.
• Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
• Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
• Enhanced overall department efficiency by developing and implementing standardized procedures for handling appeals cases.
• Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
• Educated clients on their rights and responsibilities throughout the appeals process, ensuring a clear understanding of expectations and potential outcomes.
• Increased customer satisfaction ratings through timely follow-up on appeal status inquiries, providing accurate information and addressing concerns promptly.

• Enhanced patient care by efficiently coordinating utilization management processes and reviewing medical records for case appropriateness.
• Improved workflow efficiency by collaborating with healthcare providers to ensure timely authorizations and discharge planning.
• Ensured regulatory compliance by staying updated on industry guidelines and applying them to daily tasks and assessments.
• Reduced hospital readmission rates through thorough assessment of patient needs, developing appropriate post-discharge plans.
• Facilitated effective communication between care teams, patients, and insurance companies, resulting in streamlined care coordination.
• Managed complex cases effectively, working closely with interdisciplinary teams to develop comprehensive care plans tailored to individual needs.

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• Enhanced patient outcomes by developing and implementing comprehensive behavioral health care plans.
• Collaborated with multidisciplinary teams to provide coordinated care for patients with complex needs.
• Improved patient satisfaction by regularly monitoring progress and adjusting treatment plans as needed.
• Advocated for patients'' needs within the healthcare system, ensuring access to appropriate services and supports.
• Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.

• Enhanced patient satisfaction by efficiently scheduling appointments and managing patient flow.
• Streamlined communication between patients and healthcare providers, ensuring timely responses to inquiries and concerns.
• Assisted in the development of care plans tailored to individual patient needs, improving overall health outcomes.
• Coordinated with insurance companies for accurate billing and claim processing, reducing errors and financial discrepancies.
• Trained new staff members on office procedures and protocols, ensuring consistency in patient care delivery.
• Managed sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.
• Collaborated with interdisciplinary teams to create seamless transitions between various stages of treatment plans, enhancing continuity of care.

• Enhanced patient satisfaction by efficiently scheduling appointments and managing patient flow.
• Streamlined communication between patients and healthcare providers, ensuring timely responses to inquiries and concerns.
• Assisted in the development of care plans tailored to individual patient needs, improving overall health outcomes.
• Coordinated with insurance companies for accurate billing and claim processing, reducing errors and financial discrepancies.
• Trained new staff members on office procedures and protocols, ensuring consistency in patient care delivery.
• Managed sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.
• Collaborated with interdisciplinary teams to create seamless transitions between various stages of treatment plans, enhancing continuity of care.