Claudette Grant
Decatur,GA
Summary
Accomplished healthcare administration professional with over 15 years of expertise in directing billing operations, Medicaid/Medicare compliance initiatives, and multidisciplinary teams within clinical and government-regulated environments.
Overview
27
27
years of professional experience
Work History
Account Resolution Specialist – Workers' Compensation
Select Medical
Decatur, GA
11.2021 - Current
- Managed high-volume workers’ compensation accounts, interpreting regulations and efficiently processing claims.
- Reduced claim resolution time by 20% through enhanced tracking and coordination.
- Analyzed aging accounts to resolve payment issues and negotiate settlements.
- Assessed financial data to evaluate risk associated with collections activities.
- Researched account discrepancies to identify appropriate resolutions.
- Maintained accurate records of customer interactions and updated the database.
Medical Assistant Administrator II
State of Alaska – Department of Health & Social Services
Anchorage, AK
04.2017 - 08.2018
- Oversaw Medicaid activities for long-term care, skilled nursing, and assisted living facilities, ensuring accurate claims processing and billing.
- Led initiatives that reduced payment errors by implementing corrective actions from audits and monitoring contractor compliance.
- Assessed pending claims and error reports using Health Enterprise and Congo's platforms, offering data-driven guidance for timely resolutions.
- Reviewed billing manuals, provider handbooks, and training materials to align with state and federal policy updates.
- Prepared performance and compliance reports using analytics to inform executive decisions on reimbursement strategies.
- Identified technical issues with Medicaid Management Information System (MMIS) to support long-term systems improvement.
Psychiatric Treatment Counselor (Part-Time)
Alaska Children’s Services
Anchorage, AK
01.2015 - 04.2017
- Delivered behavioral supervision and therapeutic support for children and adolescents.
- Provided crisis intervention services to prevent hospitalization during acute distress episodes.
- Provided case management services including referrals for community resources and follow-up to ensure successful implementation of the treatment plan.
- Coordinated referrals and managed treatment schedules for timely interventions.
- Documented clinical records in compliance with HIPAA regulations.
Billing Manager
The Arc of Anchorage
Anchorage, AK
04.2014 - 04.2017
- Oversaw billing operations for nine programs while leading a team of 12 billing specialists.
- Developed and implemented an integrated billing system for the Sparc program, enhancing EMR functionality.
- Researched discrepancies between customer records and internal systems.
- Prepared monthly reports on accounts receivable status and aging analysis.
- Provided support to Accounts Payable department when needed regarding vendor inquiries or dispute resolution.
- Processed customer refunds promptly upon request.
- Investigated unapplied payments or credits to determine appropriate application method.
- Maintained customer records in accounting systems ensuring accuracy of information entered into system.
Clinical Coordinator
Beacon Occupational Health
Anchorage, AK
03.2013 - 04.2014
- Coordinated medical services and patient scheduling for occupational health clients.
- Collaborated with healthcare professionals to develop treatment plans for patients.
- Monitored quality assurance activities related to clinical operations.
- Maintained detailed records of patient progress and outcomes.
- Conducted patient assessments to evaluate needs and develop individualized plans of care.
- Ensured compliance with payer policies and HIPAA through accurate data management.
Lead Scheduling Coordinator
Alliance Imaging
Anchorage, AK
02.2012 - 03.2013
- Oversaw appointment scheduling for MRI, CT, and X-ray imaging procedures.
- Developed and maintained resource plans to ensure efficient utilization of resources.
- Identified potential areas of improvement in the scheduling process and proposed solutions.
- Maintained accurate records of time tracking and budgeting for various assignments.
- Verified insurance eligibility and secured pre-authorizations for patient procedures.
- Trained scheduling staff and established process guides to ensure consistency.
Business Office Assistant
Sullivan Staffing
Anchorage, AK
10.2010 - 10.2011
- Provided comprehensive administrative support, including billing, collections, and financial reporting.
- Maintained accurate customer account records by updating contact details and payment history.
- Reconciled monthly discrepancies between accounting records and bank statements.
- Processed invoices, payments, and deposits accurately and promptly.
- Addressed customer inquiries related to billing and payment issues via telephone.
- Resolved customer complaints professionally to ensure satisfaction.
- Managed customer service operations to boost client retention and satisfaction.
Insurance Verification Specialist
Memorial Health Medical Center
Savannah, GA
07.2007 - 10.2010
- Verified insurance coverage for Medicaid, Medicare, and private payers to ensure accurate processing.
- Identified discrepancies in patient insurance coverage, ensuring data integrity in system entries.
- Managed claims appeals and coordinated benefits documentation to streamline claims processing.
- Maintained confidentiality of patient information in compliance with HIPAA regulations.
- Documented all pre-authorization requests, denials, and appeals to ensure thorough record-keeping.
Nurse’s Aide / Medical Secretary
Fairbanks Memorial Hospital
Fairbanks, AK
09.1998 - 03.2010
- Delivered direct patient care, monitored vital signs, and supported daily living activities.
- Conducted routine checks on blood pressure, blood sugar, and heart rate.
- Assisted patients with hygiene tasks to promote wellness and healthy habits.
- Safeguarded patient privacy by adhering strictly to HIPAA protocols.
- Streamlined documentation workflows to enhance operational efficiency.
- Managed scheduling, insurance forms, and record-keeping at front desk.
- Trained new staff members while ensuring efficient multi-line phone coverage.
- Answered signals and intercom systems to address resident needs.
Education
Bachelor of Science - Business Management
Wayland Baptist University
Plainview, TXMBA - Healthcare Administration
University of Phoenix
Tempe, AZSkills
- ICD-9, CPT, and HCPCS coding knowledge
- Account management
- Data analysis
- Regulatory compliance
- Customer relationship management
- Financial reporting
- Process improvement
- Microsoft Office Suite proficiency
- Team leadership
- Financial collections
- Health information management systems
- Medicaid and Medicare regulations
- HIPAA compliance expertise
- Claims processing and appeals management
- EMR and EHR systems proficiency
- Quality auditing and compliance monitoring
CORE COMPETENCIES
- Medicaid/Medicare Billing & Compliance
- Revenue Cycle Management (RCM)
- Claims Appeals & Denial Management
- Team Leadership & Development
- ICD-9 / CPT / HCPCS Coding
- Regulatory Compliance & HIPAA
- Healthcare Operations Oversight
- Financial Reporting & Budget Control
- EMR/EHR System Implementation
- Quality Assurance & Audit Readiness
- Stakeholder & Provider Relations
- Process Improvement & Training
Timeline
Account Resolution Specialist – Workers' Compensation
Select Medical
11.2021 - Current
Medical Assistant Administrator II
State of Alaska – Department of Health & Social Services
04.2017 - 08.2018
Psychiatric Treatment Counselor (Part-Time)
Alaska Children’s Services
01.2015 - 04.2017
Billing Manager
The Arc of Anchorage
04.2014 - 04.2017
Clinical Coordinator
Beacon Occupational Health
03.2013 - 04.2014
Lead Scheduling Coordinator
Alliance Imaging
02.2012 - 03.2013
Business Office Assistant
Sullivan Staffing
10.2010 - 10.2011
Insurance Verification Specialist
Memorial Health Medical Center
07.2007 - 10.2010
Nurse’s Aide / Medical Secretary
Fairbanks Memorial Hospital
09.1998 - 03.2010
Bachelor of Science - Business Management
Wayland Baptist University
MBA - Healthcare Administration
University of Phoenix