Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Brenda Graham

Fort Smith,AR

Summary

Detail-oriented professional with strong analytical and communication skills. Experienced in streamlining claims processes and resolving discrepancies to enhance efficiency and ensure accurate reimbursements.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Payment Adjustment Review- Remote

Ensemble Health Partners
Cincinnati, OH
12.2020 - Current
  • Analyzed denied and unpaid claims to identify discrepancies and root causes.
  • Evaluated payment discrepancies to determine underlying factors contributing to delays in payment.
  • Oversaw posting of contractual adjustments and denial resolutions according to payor contracts, enhancing claims processing efficiency.
  • Coordinated follow-up efforts with payors to address and expedite outstanding claims resolution.
  • Coordinated documentation and submission of technical and clinical appeals to facilitate timely outcomes.
  • Addressed payment variances and ensured prompt, accurate reimbursement processes.
  • Collaborated with management to identify trends and resolve root causes of issues.
  • Documented all interactions accurately to ensure comprehensive tracking of contact information and pertinent data.
  • Self-motivated, with a strong sense of personal responsibility
  • Daily productivity 100%.

HMS Financial Support Specialist

Shared Services Center
Fort Smith, AR
10.2016 - 11.2020
  • Managed denial submissions and ensured compliance with insurance payor requirements to facilitate efficient claims processing.
  • Daily balancing of payor accounts.
  • Review of accounts for accuracy and reconciliation of transactions.
  • Ensure variances are corrected and posted appropriately.
  • Making all corrections for contractual adjustment, denials, late charges and non covered services.
  • Apply corrections to patient demographics, charges, adjustments and payments.

Precertification Coordinator

Sparks Health System
Fort Smith, AR
01.2015 - 10.2016
  • Oversaw collaboration with insurance providers on pre-certification processes to ensure prompt and accurate approvals.
  • Conducted comprehensive reviews and validations of patient documentation to uphold accuracy and meet insurance compliance standards.
  • Engaged with medical personnel to convey pre-certification updates and outline essential follow-up procedures.
  • Conducted regular reviews of insurance policies and regulatory updates to inform and optimize pre-certification practices.
  • Ensured accuracy and validity of all processed orders.
  • Facilitated communication with insurance companies to confirm client benefits and eligibility status.
  • Supported training initiatives and fulfilled various operational duties to enhance team performance.

Education

No Degree -

University of Arkansas, Fort Smith, AR
Fort Smith

Skills

  • Computer skills
  • Organizational skills
  • Multitasking Abilities
  • Dependable and responsible
  • Attention to detail
  • Problem-solving

Certification

CRCR - Recertification September 2025

Timeline

Payment Adjustment Review- Remote

Ensemble Health Partners
12.2020 - Current

HMS Financial Support Specialist

Shared Services Center
10.2016 - 11.2020

Precertification Coordinator

Sparks Health System
01.2015 - 10.2016

No Degree -

University of Arkansas, Fort Smith, AR
Brenda Graham