Lauren Griffin
Wichita Falls,TX
Summary
Experienced Authorization Specialist, LVN, Claims Processor, data entry specialist, and medical billing and coding graduate, with a demonstrated history of working both in office and remotely. Driven performer with a strong attention to detail. Exemplary worker with highly investigative skills when processing authorizations and claims.
Overview
20
20
years of professional experience
Work History
Authorization Research Specialist III
Centene Corporation
03.2024 - Current
- Contract assignment with TEKSystems
- Ensures all assigned authorizations and errors are resolved within an appropriate time frame to avoid claim processing interference
- Builds authorizations in TruCare system when required based on report
- Reviews authorizations and system errors and resolves all issues in a timely manner to ensure processing requirements are in accordance with guidelines
- Performs outreach, researches, and resolves all open or pending authorization issues that impact claim denials, reconsiderations, or appeals
- Provides reporting on authorization issues and trends identified
- Reviews check runs for claims and system configuration accuracy
Medical Claims Processor
Carelon Behavioral Health
10.2023 - 03.2024
- Contract assignment with BC Forward
- Investigates and processes behavioral health claim updates and related claim adjustments in AS/400 system
- Performs File Reviews, issues refund requests and completes all necessary steps needed for claims processing, updates, and adjustments
- Consistently meets established productivity, schedule adherence, and quality standards
- Maintains knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations
Medical COB Claims Processor
Moda Health
12.2022 - 10.2023
- Investigates and processes COB (Coordination of Benefits) updates, COB claims, and COB related claim adjustments in FACETS system
- Performs File Reviews, issues refund requests and completes all necessary steps needed for claims processing, updates, and adjustments
- Consistently meets established productivity, schedule adherence, and quality standards
- Maintains knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations
Medical Claims Processor
UnitedHealth Group
12.2021 - 11.2022
- Provides general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims in FACETS program
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations
- Verified patient insurance coverage and benefits for medical claims
- Consistently meet established productivity, schedule adherence, and quality standards
Credentialing Coordinator
Alliance Child and Family Solutions
11.2020 - 09.2021
- Responsible for the processing of initial credentialing and re-credentialing applications for practitioners and organization/facilities, monitors applications and follow-ups
- Collecting data pertaining to application status and approvals and formatting spreadsheet to include all information obtained
- Ensuring compliance with applicable laws, regulations, procedures, and policies
Records Clerk / Aide
Tammi's Tiny Tots Childcare
Wichita Falls, USA
03.2005 - 11.2020
- Maintain company books including account payable and receivable, and bank statements
- Organize bank deposits, verify and balance receipts, and send all forms of payment to the bank
- Organize fun and educational games, read storybooks that increase children's interest, and plan outdoor activities
- Supervised free play and other activities
Medical Claims Processor
Health Care Services Corporation (BCBS)
Wichita Falls, USA
01.2019 - 12.2019
- Contract assignment with Kelly Services
- Provides general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims in AS/400 system
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations
- Managed large volume of medical claims on daily basis
- Consistently meet established productivity, schedule adherence, and quality standards
- Researched and resolved complex medical claims issues to support timely processing
Education
Medical Billing and Coding -
Trident University
08.2021
Vocational Nursing -
Vernon College
Wichita Falls, TX12.2009
Skills
- Medical Terminology
- Microsoft Office
- Electronic Medical Records
- Medical Billing And Coding
- Claims Investigation
- HIPAA Regulations
- Documentation review
- Organizational Skills
- Time Management
- Healthcare Authorizations
- Medical Claims
- Medicare and Medicaid Regulations
- Data entry and 10-key
- Clinical data entry
- Alphanumeric data entry
- Verifying data accuracy
- Meticulous attention to detail
- Maintains confidentiality
- Error identification
- Data transcription
- Document processing
- Insurance processing
- Data verification expertise
- Data organization
- Critical thinker
Timeline
Authorization Research Specialist III
Centene Corporation
03.2024 - Current
Medical Claims Processor
Carelon Behavioral Health
10.2023 - 03.2024
Medical COB Claims Processor
Moda Health
12.2022 - 10.2023
Medical Claims Processor
UnitedHealth Group
12.2021 - 11.2022
Credentialing Coordinator
Alliance Child and Family Solutions
11.2020 - 09.2021
Medical Claims Processor
Health Care Services Corporation (BCBS)
01.2019 - 12.2019
Records Clerk / Aide
Tammi's Tiny Tots Childcare
03.2005 - 11.2020
Medical Billing and Coding -
Trident University
Vocational Nursing -
Vernon College