Nina Grizzard
Tempe,AZ
Summary
Detail-oriented professional with extensive experience in claims processing and regulatory compliance. Proven track record in identifying process improvements and enhancing efficiency in healthcare billing.
Overview
14
14
years of professional experience
Work History
PFS Representative
Banner Healthcare
Mesa, Arizona
01.2023 - Current
- Collaborated with healthcare providers to resolve insurance issues.
- Reviewed accounts for accuracy and compliance with policies.
- Handled complex patient accounts with attention to detail.
- Identified areas of improvement within existing processes to increase efficiency.
- Ensured compliance with applicable laws and regulations when dealing with customer accounts.
- Created reports summarizing customer contact activity levels, resolution times, and other metrics as needed.
- Performed data entry tasks accurately to ensure proper record keeping.
- Evaluated accounts for debt placement to determine outstanding debt and coordinate with debt vendors.
- Fulfilled requests for EOBs, medical records and itemized statements.
- Conducted outbound collection calls to gather payment on open balances.
- Coordinated with other departments such as coding and accounts receivable to resolve payment and billing issues.
- Posted discounts and adjustments to patient accounts.
- Recorded information about status of collection efforts.
- Located and notified customers of delinquent accounts by mail, telephone, or personal visits to solicit payment.
- Monitored overdue accounts using automated information systems.
Revenue Cycle Specialist
ARS
Scottsdale, Arizona
04.2019 - 01.2023
- Managed patient billing inquiries and resolved discrepancies efficiently.
- Reviewed claims submissions for accuracy and compliance with regulations.
- Coordinated with insurance companies to verify coverage and benefits.
- Analyzed payment trends to identify areas for process improvement.
- Trained new staff on revenue cycle procedures and best practices.
- Implemented systems to streamline the accounts receivable process effectively.
- Collaborated with clinical teams to ensure accurate documentation for billing.
- Maintained up-to-date knowledge of healthcare regulations affecting revenue cycles.
- Processed appeals related to denied or rejected claims in a timely manner.
- Collaborated with other departments to resolve customer inquiries regarding billing issues.
- Contacted insurance providers to check patient coverage.
- Researched discrepancies on unpaid invoices and reconciled them.
- Audited payments from third-party payers to ensure accuracy of reimbursement amounts.
- Ensured all regulatory requirements were met when submitting claims for payment.
- Reviewed patient accounts to ensure accuracy and completeness of information.
- Maintained current knowledge of insurance policies, procedures, regulations, and guidelines.
- Monitored accounts receivables daily to determine appropriate follow-up action needed.
- Performed account reconciliations between insurance companies and internal systems.
- Identified and corrected payment problems involving patients or third-party payers.
Concierge Services Representative
Oscar Health
07.2017 - 09.2018
- Answer inbound calls from members
- Assist members understand their plans benefits, copayments deductibles and maximum out of pocket amounts and how they apply to their plans
- Assist members with understanding claims through research and detailed explanation
Care Enrollment Guide
Oscar Health
07.2017 - 09.2018
- Answer inbound calls from prospective members
- Educate prospective members on the plans offered
- Enroll members in appropriate health care plans based on their needs both on and off the exchange
Claims Information and Research Analyst
Aetna
07.2015 - 01.2017
- Answer incoming phone calls from providers to identify the type of assistance needed (i.e. billing and payments, authorizations for treatment and explanation of benefits (EOBs)
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
- Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the provider
- Review and research incoming healthcare claims from members and providers(doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates) and reprocess claims when necessary
- Communicate and collaborate with providers to resolve issues, using clear, simple language to ensure understanding
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
Provider Resolution Specialist/Interim trainer
United Healthcare
04.2012 - 06.2015
- Respond to complex inbound provider calls and written inquires
- Assists with escalated issues
- Resolve inquiries which could include: Benefit and Eligibility information, Billing and Payment issues, Physician assignments, Authorization for treatment, Explanation of Benefits (EOB)
- Provide excellent service
- Constantly exceed established productivity, schedule adherence, and quality standards
- Assisted in formal education processed of call center staff while supporting the Training and Development department
- Provided web based training to call center staff using webex
- Peer coach and team subject matter expert
Education
High School Diploma -
Marcos de Niza High School
Skills
- Care One
- PSI
- Macess EXP
- Facets CSP
- Citrix
- Unix
- Pega
- Trizetto
- PowerPoint
- Excel
- Outlook
- Webex
- Microsoft
- Medical billing
- Claims processing
- Account reconciliation
- Regulatory compliance
- Payment resolution
- Data entry accuracy
- Problem solving
- Attention to detail
- Effective communication
- Team collaboration
- Training and mentoring
- CRM software usage
- Call center experience
- Strong interpersonal skills
- Problem-solving
- Documentation skills
- Legal compliance
- Billing dispute resolution
- Bill processing
Computer Skills - Systems And Software
- Care One
- PSI
- Macess EXP
- Facets CSP
- Citrix
- Unix
- Pega
- Trizetto
- PowerPoint
- Excel
- Outlook
- Webex
- Microsoft
Timeline
PFS Representative
Banner Healthcare
01.2023 - Current
Revenue Cycle Specialist
ARS
04.2019 - 01.2023
Concierge Services Representative
Oscar Health
07.2017 - 09.2018
Care Enrollment Guide
Oscar Health
07.2017 - 09.2018
Claims Information and Research Analyst
Aetna
07.2015 - 01.2017
Provider Resolution Specialist/Interim trainer
United Healthcare
04.2012 - 06.2015
High School Diploma -
Marcos de Niza High School