Lashawn L Grigsby
Waxahachie,TX
Overview
13
13
years of professional experience
Work History
Claims Processor
Horace Mann
Irving, TX
11.2014 - Current
- Entering all medical claims for BI and Med PIP teams
- Handling calls for payment status
- Updating provider address and verifying tax id information
- Assisted colleagues in resolving complex or challenging cases by providing guidance based on expertise in specific areas.
- Using Excel, Email, Microsoft Word
- Mailing status requests to claimants
- Contacting Providers for missing information to have claims paid
- Creating spreadsheets for requested data
- Handle the Michigan RFR's for reimbursement
- Directing Medical Bills in AIS to adjusters
- Contributed ideas for process improvements during team meetings or brainstorming sessions.
- Paid vendors for negotiating bills
- Collected additional information from insured parties by telephone, email and letter.
- Calculated claims amounts and submitted paperwork for payment or review.
Relations Representative/ Workers Compensation
CorVel Corporation
Addison, TX
09.2013 - 10.2014
- Assist providers in getting contracted/ credentialed with a workers compensation network
- Assist credentialing specialists with Non-Renew letters, sending welcome letters to newly added providers, Researching Provider license numbers for sanctions and current status
- Handle all delegated providers and prepare providers for committee and nominations
- Update Exhibit B, which is the legal portion of a medical contract establishing rates and providers working at each facility
- Send Requests to NDB through Share point as a task
- Creating spreadsheets, creating standard responses to provider requests to be in the provider network
- Emailing lists of providers and performing audits of each delegated accounts
- Handle current provider nominations to the network
- Searching provider license and NPI on TDI Website
- Updating monthly Sanctions report from TDI
- Verifying in the system if the provider is contracted with our network and sending Non-renew letters for providers with sanctions
- Processing Rejected Claims according to contract
Eligibility/Benefits Specialist
Parrollon Healthcare Business Solutions
Irving, TX
04.2013 - 09.2013
- Assisted uninsured patients in getting assistance through the Medicaid Programs, Chips programs, SSI Medicaid, and SSDI
- Followed up with patients who qualified for government programs
- Checked with State case workers to determine when benefits started and getting hospital bills paid., Researched all benefits for mental health and wellness
- Updated the benefit packages
- Completed ticket or task requests via SharePoint
- Emailed requests for updated benefits for employer groups
- Assisted members and HR with benefits requests
- Explained mental health benefit payments
- Performed research using Medivance and CAS Systems
Timeline
Claims Processor
Horace Mann
11.2014 - Current
Relations Representative/ Workers Compensation
CorVel Corporation
09.2013 - 10.2014
Eligibility/Benefits Specialist
Parrollon Healthcare Business Solutions
04.2013 - 09.2013