Amari Griddine
Frisco,TX
Summary
Tenacious Referral Specialist with 8 years connecting clients with medical providers. Successful working with insurance companies and other medical professionals to obtain prior authorization and set up essential client appointments. Applies proactive approach to problem-solving and resourceful use of industry network.
Overview
7
7
years of professional experience
Work History
Benefits Referral Specialist , Project Manager
New Directions Behavioral Health
Overland Park, Kansas
2019.07 - 2021.01
- Receive initial calls from providers, clients, and members, routing appropriate calls to their respective departments
- Verify demographic information, and providing benefits, claims, and basic billing/coding information in accordance with HIPPA law
- Essential that each CSR be able to handle information such as where to send claims, how to identify appropriate benefits, describe product information to providers and members, assist other departments in attempting to solve more basic issues before transferring calls
- Triage crisis callers to clinical staff for appropriate assistance
- Assessing levels of risk beyond the customer service scope
- Assist with status checks of authorizations for additional services, and basic appeals inquiries
- Provide routine referrals to callers to network providers
- Provide relevant paperwork for providers to adjust demographic information in the system, and to obtain authorization for further treatment for their patients
- Cross train on additional books of business as required by team
- Able to work simultaneously between multiple systems to provider member/provider mental health benefits
- Telephonically respond to and resolve routine claims status questions and provide information related to denials or claims submission
- Triage to the appropriate staff, department or third-party administrator when not routine
- Demonstrates use of MAGIC customer service concepts in all communication
- Willingness to work a variety of shifts if necessary
- Cross trained in different lines of business.
- Linked families to relevant community support to meet non-medical needs.
- Scheduled appointments with specialists on behalf of clients.
- Fostered relationships with vendors to promote positive working relationships.
- Managed projects from procurement to commission.
- Achieved project deadlines by coordinating with contractors to manage performance.
Pre-Services Rep
Cerner
Kansas City, MO
2018.03 - 2019.02
- Verify insurance, calculate amount due , collect payment
- Confirm appointments
- Follow-up of aging Accounts Receivable insurance claims
- Process claims that are denied through appeal or reprocessing procedures
- Understand and apply appropriate adjustment types
- Analyze underpayments and manage the appeals process
- Interpret Explanation of Benefits including allowed amounts, discounts, in/out-of-network benefit levels, deductibles, coinsurances and copays
- Process paper and electronic claims
- Apply ICD9 and CPT code knowledge when reviewing accounts for collections
- Apply company Special Instructions for processing claims for carriers and practices
- Assist with patient insurance verification process as needed
- Apply patient payments to accounts, as needed
- Answer calls regarding insurance claims and benefits
- Maintain or exceed the daily goal for accounts worked
- Assist with mentoring and training new collectors, if the skill level is appropriate
- Collect data affecting patient admissions and coordinate the information-exchange between hospitals and physician -contact patients to discuss benefits, confirm or obtain missing demographics information, - calculate cost share and assist with financing options, and provide pertinent information for day-of appointments
- Identify and obtain insurance benefits authorization and proper verification.
Patient service representative
Triwest Healthcare Alliance
2017.06 - 2017.08
- Schedule appointments
- Verify patients' insurance information to determine eligibility
- Provide doctors with information on physical findings
- Register patients by verifying records
- Collect payments from patients once medical services are rendered
- Review medical records to ensure completeness and file information appropriately
- Manage data entry procedures such as entering procedure codes and diagnosis into databases
Customer Service Representative
H&R Block
Kansas City, MO
2014.12 - 2017.01
- Outbound calls, -collections-Tax training school Enrollment-message taker-appointment scheduler -Assisting client with their credit card issues-locating balances, money transfer, deposits, purchases-locating Tax refund, providing clients with IRS information
- Receptionist for H&R Block Field offices-verify accounts, -Escalations Case resolver-Research information
- Collections
Education
Associate of Applied Science - Clinical Nurse Specialist
National American University - Rapid City
Kansas City, MO01.2026
High School Diploma -
Central High School
Kansas City 05.2010
Associate of Applied Science - Applied Psychology
Colorado Christian University
Denver, CO01.2028
Associate of Arts - Criminal Justice
Metropolita Community Collage
Kansas City, MO01.2029
No Degree - Certified Nursing Assistant
All Is Well
Little Elm, TXSkills
- Equipment Troubleshooting and Maintenance
- Critical Thinking
- Customer Service
- Medical Recordkeeping
- Claim Forms
Timeline
Benefits Referral Specialist , Project Manager
New Directions Behavioral Health
2019.07 - 2021.01
Pre-Services Rep
Cerner
2018.03 - 2019.02
Patient service representative
Triwest Healthcare Alliance
2017.06 - 2017.08
Customer Service Representative
H&R Block
2014.12 - 2017.01
Associate of Applied Science - Clinical Nurse Specialist
National American University - Rapid City
High School Diploma -
Central High School
Associate of Applied Science - Applied Psychology
Colorado Christian University
Associate of Arts - Criminal Justice
Metropolita Community Collage
No Degree - Certified Nursing Assistant
All Is Well