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Alice Grady
Healthcare Revenue Cycle/Medical Billing & Credentialing Specialist
Glenolden,PA
Work Preference
Work Type
Full TimeLocation Preference
RemoteSummary
Experienced Revenue Cycle Specialist skilled in claims processing, denial management, and EHR systems. Successfully managed medical claim remittance notices, ensuring timely resolutions and maximizing revenue through diligent analysis and correction of claims discrepancies.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Revenue Cycle Medical Billing Specialist
Wills Eye Hospital
Phialdelphia
11.2022 - Current
- Managed medical claim remittance notices, ensuring timely resolution with insurance carriers.
- Drafted and submitted appeal letters with supporting documentation, securing payment for services rendered.
- Reviewed and corrected claims coding errors, collaborating with insurance carriers to facilitate accurate processing.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Analyzed rejected claims and corrected errors as necessary before resubmitting them for payment.
- Contacted insurance companies to discuss and clarify claim discrepancies.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Collaborated closely with other departments to resolve claims issues.
- Monitored aging accounts receivable balances ensuring timely resolution of outstanding balances.
- Maintained timely and accurate charge submission through electronic charge capture, including billing, and account receivables (BAR) system and clearing house.
- Verified the accuracy of claim data prior to submission to insurance carriers.
- Analyzed and interpreted patient medical and surgical records to determine billable services.
- Researched complex billing issues involving multiple providers or services rendered over a period of time.
- Meticulously tracked and resolved underpayments.
- Worked closely with clinical staff to ensure accurate coding practices were followed.
- Maintain up-to-date knowledge of healthcare regulations and billing practices.
- Recorded charges, payments, and adjustments in the billing system.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Submitted appeals using provider portals and phone communication.
- Reviewed claims for coding accuracy.
- Conducted daily identification of surgical cases to facilitate precise billing.
Claims Review Analyst
UnitedHealthcare
Horsham
02.2021 - 09.2022
- Identified all surgical cases daily for efficient resource allocation.
- Entered billing codes accurately, adhering to company standards and best practices.
- Ensured clear, concise account documentation with all necessary information included.
- Maintained medical claim remittance notices for specific insurance carriers.
- Executed cash postings promptly as instructed.
- Contributed effectively as a team member in achieving departmental goals.
- Sent appeal letters with required documentation to secure service payments.
- Reviewed and corrected claim coding errors while coordinating with insurance carriers.
Durable Medical Equipment Coordinator
Health Partner Plans
Philadelphia
09.2016 - 11.2020
- Approved authorization requests for durable medical equipment.
- Identified and processed requests for durable medical equipment from program participants.
- Coordinated procurement and maintenance of equipment to support healthcare operations.
- Processed paperwork for rental agreements, warranties, and invoices.
- Ensured quality and accuracy through thorough checks of completed work.
- Strengthened operational efficiencies by multitasking with heavy equipment to ensure timely project completion.
- Used appropriate tools and materials while adhering to safety protocols and industry best practices.
- Participated in annual audit preparations alongside care services director.
Provider Relations Coordinator
Cigna-HealthSpring
Philadelphia
10.2009 - 09.2016
- Maintained accurate provider databases and records to support efficient provider management.
- Oversaw provider data updates, including contact information and credentialing status.
- Developed relationships with providers to ensure compliance with contractual obligations.
- Facilitated dispute resolution between organization and contracted providers.
- Tracked all correspondence between organization and providers for record-keeping purposes.
- Collaborated with multiple departments on projects related to provider relations.
- Managed administrative tasks, including filing, scanning, and photocopying.
Precertification Specialist
Cigna-HealthSpring
Philadelphia
10.2009 - 09.2016
- Managed precertification requests for medical services and procedures, ensuring compliance with timelines.
- Compiled and submitted precertification requests for payer review based on established guidelines.
- Assessed medical necessity for requested services by reviewing patient medical records.
- Evaluated clinical criteria against health plan guidelines to determine authorization outcomes.
- Clarified treatment plans and requirements for patients through collaboration with healthcare providers.
- Assisted healthcare providers with inquiries regarding preauthorization processes and requirements.
- Resolved issues and obtained necessary information by coordinating with various departments.
- Maintained comprehensive documentation of all precertification activities throughout the process.
Claims Research Analyst
Cigna-HealthSpring
Philadelphia
10.2009 - 09.2016
- Reviewed and researched incoming claims, navigating multiple computer systems to accurately capture critical data.
- Processed claims according to specified procedures while meeting production and quality benchmarks.
- Ensured proper benefits applied to each claim by adhering to established policies and guidelines.
- Handled complex claim situations, analyzing problems and implementing optimal resolutions for customers and providers.
- Recognized when to refer complicated claims to external firms and monitored submissions to internal support units.
- Maintained productivity schedule adherence and quality standards consistently.
- Assisted in evaluating new healthcare initiatives, identifying opportunities to enhance operational efficiency.
- Utilized various tools, including spreadsheets and databases, for effective data analysis.
Specimen Processor
AmeriPath Dermatology
Philadelphia
11.2005 - 06.2008
- Prepared specimens by labeling, sorting, and organizing for efficient workflow.
- Collaborated with healthcare professionals to ensure proper specimen handling protocols.
- Trained new staff on specimen processing techniques and laboratory procedures.
- Documented specimen details in electronic systems for tracking and compliance purposes.
- Assisted in inventory management of lab supplies to support continuous operations.
- Processed specimens and prepared them for testing according to established procedures.
- Maintained a clean work environment by adhering to infection control guidelines.
- Recorded specimen data into laboratory information systems accurately and efficiently.
Education
Certificate of Technical Studies - Credentialing Specialist Course
04-2026
Certificate of Technical Studies - Medical Billing & Coding
10-2008
High School Diploma -
06-1988
Certificate of Technical Studies - Revenue Cycle Management Specialist Course
06-2026
Skills
- Billing and coding
- Claims processing
- Denial management
- Receivable management
- EHR systems proficiency
- Database management
- Data analysis
- HIPAA compliance
- Medical terminology expertise
- Critical thinking
- Verbal and written communication
- Excel proficiency
- Attention to detail
Certification
- Credentialing Specialist
Timeline
Revenue Cycle Medical Billing Specialist - Wills Eye Hospital
11.2022 - Current
Claims Review Analyst - UnitedHealthcare
02.2021 - 09.2022
Durable Medical Equipment Coordinator - Health Partner Plans
09.2016 - 11.2020
Provider Relations Coordinator - Cigna-HealthSpring
10.2009 - 09.2016
Precertification Specialist - Cigna-HealthSpring
10.2009 - 09.2016
Claims Research Analyst - Cigna-HealthSpring
10.2009 - 09.2016
Specimen Processor - AmeriPath Dermatology
11.2005 - 06.2008
AAPC - Certificate of Technical Studies, Credentialing Specialist Course
All State Career - Certificate of Technical Studies, Medical Billing & Coding
Germantown High School - High School Diploma,
AAPC - Certificate of Technical Studies, Revenue Cycle Management Specialist Course