Priscilla Grigsby
Summary
Experienced medical collector with 10+ years of professional experience and eight years of experience within the UCLA Health system. Proven track record of successfully managing high‐volume accounts, increasing the revenue for UCLA while simultaneously taking extra care to significantly reduce aging accounts. Demonstrated financial acumen, with a strong knowledge of the physician revenue cycle and UCLA governance principles. Extensive background knowledge in commercial, Medicare, Medicaid, HMO/PPO, and Tricare insurance operating procedures and contracts, working extensively with insurance providers to reconcile claims.
Overview
11
11
years of professional experience
Work History
Patient Biller III (Plastic & Surgical Oncology)
UCLA FPG/LAX
Los Angeles, CA
12.2018 - Current
- Follow up on claims processing to ensure timely payment
- Ensure that all the patient information is accurately entered in the system
- Formatted appeal letters, retrieved appropriate medical records, and documentation to support the claim, and filed appeals with insurance companies to resolve disputes
- Coordinated with insurance companies to reconcile denials and provide supportive documentations for proper claim process
- Resubmit corrected claim and/ or appeal for the reprocessing for proper reimbursement
- Contacted patient and/or physician office to obtain information and/or documents for process of the claim
- Reviewed claim denied for payment and underpaid claims; and verified the payment adjustments
- Advised in resolution of customer billing issues through typical inquiries
- Ensure all collection activity information is entered accurately into system
- Identified and notified supervisor of any contractual issues, as well as identifying new trends of insurance's improper or inconsistent denials
- Collaborated with management, front office staff, liaison, and other team members to reduce aging of accounts by providing verbal and written communication
- Generate and follow- up on quarterly reports for the physician's regarding aging
- Contribute to team environment by performing other duties as assigned.
Patient Biller III (Ophthalmology)
UCLA FPG/LAX
Los Angeles, CA
05.2017 - 12.2018
- Follow up on claims processing to ensure timely payment
- Ensure that all the patient information is accurately entered in the system
- Formatted appeal letters, retrieved appropriate medical records, and documentation to support the claim, and filed appeals with insurance companies to resolve disputes
- Coordinated with insurance companies to reconcile denials and provide supportive documentations for proper claim process
- Resubmit corrected claim and/ or appeal for the reprocessing for proper reimbursement
- Contacted patient and/or physician office to obtain information and/or documents for process of the claim
- Reviewed claim denied for payment and underpaid claims; and verified the payment adjustments
- Advised in resolution of customer billing issues through typical inquiries
- Ensure all collection activity information is entered accurately into system
- Identified and notified supervisor of any contractual issues, as well as identifying new trends of insurance's improper or inconsistent denials.
Administrative Assistant II (Cash Posting)
UCLA FPG/LAX
Los Angeles, CA
05.2015 - 05.2017
- Reviewed insurance and patient's payment, process adjustments, payment corrections and transfers where applicable
- Obtained necessary backup by utilizing the in house imaging system, banking, and insurance payer websites
- Reviewed accounts to determine appropriate action, adjustments, payment correction and or posting refund
- Updated account with clear detailed comments regarding activity
- Manually processed credit card & mailed in checks batches
- Researched unidentified payments in remittance work queue
- Completed 55 accounts or more per day to successfully meet and or exceed quotas
- Collaborated with management to reduce aging of accounts by providing verbal and written communication
- Performed other related duties as directed by supervisor.
Senior Collector
PROFESSIONAL TECHNOLOGY BILLING
Torrance, CA
05.2013 - 04.2015
- Prepared and submitted clean claims to various insurance companies electronic and paper
- Reviewed EOB from insurance carriers for correct payment
- Performed appeals and reconsiderations to all insurance carriers
- Averaging 70-80 calls weekly to insurance carriers, law offices, and patients
- Verified patient's insurance coverage and authorizations
- Followed up on unpaid claims within standard billing cycle time frame
- Billed secondary and tertiary insurance claims with primary EOB
- Notified patients of outstanding balances and process monthly statements for patient accounts
- Handle large volume of litigated claims
- Filed liens, DOR(s), and other applications with the WCAB
- Collection and litigated claims with Worker Compensation
- Preparation of litigated files for court hearings.
Education
Master of Health Administration - in process -
University of Phoenix
Bachelor of Science in Health Management -
University of Phoenix
Medical Billing/ Coder Diploma -
Everest College
Associate Degree in Business Administration -
El Camino Community College
Skills
- Knowledgeable of commercial, Medical, Medicaid, HMO/PPO, Tricare insurance operating procedures, contracts, and basic medical terminology
- Ability to promote and deliver quality work and service
- Extensive experience with medical billing for commercial insurance
- Experience working Accounts Receivable aging
- Prepared and distributed work aged account receivables report
- Ability to work under time constraints and pressure
- Able to multitask efficiently and effectively
- Strong organization skills
- Great interpersonal skills
- Proficient with Microsoft Word, Excel, and PowerPoint
- Reviewed claim denied for payment and underpaid claims; and verified payment adjustments
- Collaborated with management, front office staff, and team members to reduce aging of accounts by providing verbal and written communication
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Patient Biller III (Plastic & Surgical Oncology)
UCLA FPG/LAX
12.2018 - Current
Patient Biller III (Ophthalmology)
UCLA FPG/LAX
05.2017 - 12.2018
Administrative Assistant II (Cash Posting)
UCLA FPG/LAX
05.2015 - 05.2017
Senior Collector
PROFESSIONAL TECHNOLOGY BILLING
05.2013 - 04.2015
Master of Health Administration - in process -
University of Phoenix
Bachelor of Science in Health Management -
University of Phoenix
Medical Billing/ Coder Diploma -
Everest College
Associate Degree in Business Administration -
El Camino Community College
Similar Profiles
Gregory Jackson IIGregory Jackson II
Sr. Clerk at UCLA FPGSr. Clerk at UCLA FPG
Lindsey WilsonLindsey Wilson
Clinical Care Coordinator - Orthopedic/trauma at FPG With Sarasota Memorial HospitalClinical Care Coordinator - Orthopedic/trauma at FPG With Sarasota Memorial Hospital
Nevis PonceNevis Ponce
Housekeeper at FPGHousekeeper at FPG
Shaqwan FincherShaqwan Fincher
Medical Coder at Humana Medical Insurance RemoteMedical Coder at Humana Medical Insurance Remote
Levorica AllenLevorica Allen
Membership Services Representative at Elevance HealthMembership Services Representative at Elevance Health