Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Gricedia Perez-Woody

Zebulon,NC

Summary

Accomplished Healthcare Medical Billing Specialist with extensive experience in managing and optimizing the medical billing process. Expert in the accurate and timely submission of insurance claims, payment posting, and reconciliation of accounts, ensuring compliance with regulatory standards such as HIPAA. Proven ability to navigate complex coding systems and payer policies, with a deep understanding of revenue cycle management. Demonstrates exceptional analytical skills and proficiency in industry-standard billing software, contributing to enhanced financial performance and reduced claim denials. Renowned for meticulous attention to detail, strategic problem-solving capabilities, and a collaborative approach to interfacing with healthcare providers, insurance carriers, and patients. Committed to advancing operational efficiency and achieving superior financial outcomes within dynamic healthcare environments.

Overview

8
8
years of professional experience

Work History

Care Coordinator

Mercalis
04.2020 - 08.2024


  • Provide patients with detailed information about their medications, including usage instructions.
  • Answered 100(avg.) calls per day exceeding metrics. Provided prompt support with a professional, friendly, patient attitude.
  • Proactively memorized over 55 company products and services.
  • Manage patient enrollment in pharmaceutical support programs, including data collections, record-keeping and reporting.
  • Coordinate with healthcare providers to ensure accurate and timely fulfillment of prescriptions, addressing any issues related to medication adherence or side effects.
  • Maintained unwavering confidentiality of protected health information(PHI) to uphold rigorous compliance with HIPAA regulations.

Posting and Revenue Cycle

Fastmed.
09.2017 - 06.2020
  • Execute precise posting of payments and adjustments to patient accounts, ensuring all transactions are accurately recorded within the financial system.
  • Conduct thorough reconciliations of patient accounts, addressing and resolving discrepancies related to payments, denials and adjustments in a timely manner.
  • Manage the preparation and review to patient and insurance billing statements, handle patient inquires, and conduct follow-ups on outstanding balances.
  • Ensure compliance with all relevant regulatory requirements and company policies throughout the revenue cycle process.
  • Engage with finance, billing and other relevant departments to streamline processes and resolve any issues effectively.

Support Coordinator

Trial Card Inc.
09.2018 - 03.2019
  • Verified Patients eligibility and claims status with government, commercial insurance payers, and pharmacy benefit managers
  • Generated and maintained working relationships with providers and pharmaceutical area managers in 50 states
  • Specialty pharmacy process utilized for chronic disease management
  • Conducted research to identify appropriate alternate funding sources to follow each case from start to finish to ensure timely delivery of mediations to provider office
  • Initiate referrals to patient foundation programs and copay assistance programs
  • Actively maintained current working knowledge of CPT and ICD 10 coding principles, government regulation, protocols and third-party requirements regarding insurance
  • Buy and bill experience with complex cases.

Billing Specialist

PFS Group
07.2016 - 10.2017
  • Accurately prepare and submit healthcare claims to insurance carriers and governmental payers in accordance with established coding and billing protocols.
  • Post payments and adjustments to patient accounts, ensuring reconciliation of discrepancies and accurate financial reporting.
  • Manage patient accounts by resolving billing inquires, addressing claim denials, and following up on outstanding balances to enhance revenue recovery.
  • Provide professional and responsive support to patients and insurance companies regarding billing statements, payment queries, and insurance issues.
  • Maintain comprehensive and accurate billing records, ensuring adherence to healthcare regulations, coding standards, and internal policies to mitigate the risk of non-compliance.
  • Prepare detailed reports on billing activities, claim statuses, and financial performance to support the organization's revenue cycle management efforts.

Education

Diploma - Education

Adalie Stevenson High School
06.1985

Skills

  • Salesforce
  • EHR

References

Available upon request

Timeline

Care Coordinator

Mercalis
04.2020 - 08.2024

Support Coordinator

Trial Card Inc.
09.2018 - 03.2019

Posting and Revenue Cycle

Fastmed.
09.2017 - 06.2020

Billing Specialist

PFS Group
07.2016 - 10.2017

Diploma - Education

Adalie Stevenson High School
Gricedia Perez-Woody