Lashawn Grigsby
Waxahachie,TX
Summary
I have over 20 years of experience in the healthcare field. I'm also familiar with various sections of healthcare, ie, Medicare, and Medicaid, as well as familiarity with Mental Health and Workers' Compensation. Furthermore, I have great project management skills and also work well either alone or with a group. I will bring a vast amount of knowledge, skills, and experience to the table. I have also worked in Claims Auto Insurance and have been very successful with the MCCA MI program and headed the clean-up project which netted the company over 4.2 Million dollars.
Overview
12
12
years of professional experience
Work History
Claims Processor
Horace Mann
11.2014 - Current
- Entering all medical claims for BI and Med PIP teams
- Handling calls for payment status
- Updating provider address and TIN's
- 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
- Meeting daily goals and expectations from Management
- Contacting Providers for missing information to have claims paid
- Also putting together payment ledgers
- Noting all accounts of all actions taken
- Create spreadsheets
- 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
- Negotiated settlement amounts with claimants or their representatives in timely manner
- Paid out uncomplicated Vendors
- 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
09.2013 - 10.2014
- Assist providers with getting contracted/ credentialed with 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 are 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 request to be in workers compensation 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
- Sending Requests to NDB
Eligibility/Benefits Specialist
Parrollon Healthcare Business Solutions
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
- 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
- Documented all information clearly and concisely
Education
Associate of Arts - Law
University of Phoenix
Phoenix, AZ05.2024
Sanford Brown Institute - Psychology
Grand Canyon University
Dallas, TX05.2010
Skills
- Microsoft Office Applications
- Healthcare technology experience
- EVIPS
- Med data
- CWS
- Claims Reduction Adjustments
- Med data Toolbox
- AIS
- Guidewire MCCA Process for Michigan
- Sharepoint
- Claims Assistant duties
- AS400
- Epic
- Dimension
- Meditech
- Artiva
- Cisco Phone Systems
- HPF
- PCI
- Excellent Customer Service skills
- MedCheck
- Vistar
- EPIC Systems knowledge
- National Data Base for Providers
- Great Communications Skills
- Self Starter
Additional Information - Licenses Honors Awards
- Bravo Nominee Award- 2018
- Employee of the Month Nominee for entire company-2017
- Birthday committee leader/organizer
Certification
- Six Sigma Certification
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
Associate of Arts - Law
University of Phoenix
Sanford Brown Institute - Psychology
Grand Canyon University
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