Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
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Lauren Najmolhoda

Grandville,MI

Summary

I am an accomplished Business Analyst with a proven track record at Centene. Adept in ICD-10 and Excel, pairing with my strong communication skills and passion to help teammates, I break down complex medical coding guidelines to spearhead positive business solutions.

Overview

12
12
years of professional experience

Work History

Business Analyst II

Centene
Remote
06.2023 - Current
  • Was hired in as a level two analyst due to my extensive background in the field and commitment to detail
  • In 2024, one of only two members of my team to lead an initiative that was approved and went through implementation, saving the company $10 million
  • Continuously am proactive in keeping up to date and educating myself in medical coding guidelines and regulation
  • Consistently meets or exceeds deadline related quotas, including leading projects with Excel driven reporting, detailed analysis, and preparing presentations for recommended business solutions

Provider Compliance and Claims Supervisor

Community Mental Health of Ottawa County
Holland, MI
02.2022 - 06.2023
  • Oversaw the claims submission and vendor payment process
  • Directly supervised, coached, and motivated Claims and Billing Clerks to achieve set performance goals
  • Provided support, training and presenting to contract agencies, and administered a central claim help desk to maintain claims efficiencies through the billing cycle
  • Chosen to attend a three day training seminar for our processing system

Accounts Receivable Specialist

ProCare Pain Solutions
Grand Rapids, MI
09.2020 - 02.2022
  • Oversaw three pain management clinics, keeping track of the processing of all the claims that were created daily
  • Processed claims in a timely manner, ensuring the clinics received payment in accordance with their policy while also deciphering any CPT code errors that could have prevented claims from being processed efficiently
  • Other tasks handled daily included taking patient calls/inquires, processing payments, and helping answer any questions that they may have

Billing Specialist

Metro Health
Wyoming, MI
10.2019 - 09.2020
  • Promoted to Billing Specialist in September 2019
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes
  • Verified proper coding on all claims in a given week, investigated and resolved issues to maintain billing accuracy
  • Established, enforced and optimized billing policies and procedures to maximize revenue, and minimize balances

Gynecologic Oncology Referral Specialist

Metro Health
Wyoming, MI
02.2019 - 10.2019
  • Promoted to Referral Specialist in February 2019, and was integral piece in transitioning an entire team (physicians and nurses) from Mercy Health
  • Responsible for guiding patients with the next step in their journey, using empathy and compassion, while at the same time tackling operational tasks from the Gynecologic Oncology team
  • Consistently sent out referrals for radiation, chemo therapy, radiology, and physicians
  • Prior authorizations were tasks that were prevalent in day-to-day duties, with a heavy focus on Evicore and AIM

Medical Office Support

Metro Health OB/GYN at Metro Health Village
Wyoming, MI
10.2017 - 02.2019
  • Assisted in patient registration, insurance verification for procedures and surgeries, check-out, and patient/surgery scheduling
  • Responsible for rotating between three different locations, and worked primarily with two different doctors

Medical Records and Scheduling

West Michigan OB/GYN and Spectrum Health OB/GYN
Grand Rapids, MI
09.2012 - 10.2017
  • Assisting with medical records, check-in, check-out, scheduling, insurance data, and directing phone calls
  • Communicated with patients with compassion while keeping medical information private
  • Transitioned to the same role as West Michigan OB/GYN within Spectrum, as the practice was bought in August 2015

Education

Medical Insurance Billing -

American Medical Billing Association

Certified Professional Coder- Apprentice -

AAPC
2021

CPC Course Certified - Coding and Billing

AAPC
2015

Business And English Courses -

Grand Rapids Community College

High School Diploma -

Grandville High School
2004

Skills

  • CPC-Certification through AAPC
  • ICD-10 proficient
  • Credentialing and paneling
  • Constant and dynamic communication with teammates
  • Excel proficient
  • Familiar with EMR's such as Epic; Greenway; and Netsmart
  • Billing and claims processing

Accomplishments

  • Received high-performance ratings in Medical Office Support department for 2015/2016
  • Received a scholarship from the Grand Rapids AAPC Chapter in 2015 due to high performance in coding courses
  • 90%+ ratings with patient satisfaction every month from patient surveys

Timeline

Business Analyst II

Centene
06.2023 - Current

Provider Compliance and Claims Supervisor

Community Mental Health of Ottawa County
02.2022 - 06.2023

Accounts Receivable Specialist

ProCare Pain Solutions
09.2020 - 02.2022

Billing Specialist

Metro Health
10.2019 - 09.2020

Gynecologic Oncology Referral Specialist

Metro Health
02.2019 - 10.2019

Medical Office Support

Metro Health OB/GYN at Metro Health Village
10.2017 - 02.2019

Medical Records and Scheduling

West Michigan OB/GYN and Spectrum Health OB/GYN
09.2012 - 10.2017

Medical Insurance Billing -

American Medical Billing Association

Certified Professional Coder- Apprentice -

AAPC

CPC Course Certified - Coding and Billing

AAPC

Business And English Courses -

Grand Rapids Community College

High School Diploma -

Grandville High School

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