Hi, I’m
Stephanie Grier
Certified Revenue Cycle Representative
Warner Robins,GA
I can do all things through Christ which strengtheneth me
Philippians 4:13
Summary
Well-qualified Revenue Cycle Specialist with strong attention to detail and in-depth understanding of billing procedures. Excellent planning and problem-solving abilities. Prepared to bring 15 years of related experience to a dynamic position with room for career growth.
Overview
11
years of professional experience
1
Certification
Work History
Signature Performance
Certified Revenue Cycle Representative
04.2020 - Current
Job overview
- Submit UB-04 and HCFA-500 electronic claims via Cerner,SSI, carrier portal entry/upload, and paper for Medicare, Medicaid/Medi-Cal, Commercial, Workers' Comp, and Auto carriers
- Work rejected claims due to invalid patient demographics, coding/charge entry errors
- Contact insurance companies by phone, email, or online portal to follow up and confirm receipt/status of claims, obtain payment info/denial reason
- Analyze complex Explanations of Benefits to work denials and verify copay/coinsurance /deductibles, insurance allowable, and contractual adjustment
- Prepare, and abstract medical records from PowerChart to submit along with provider disputes/reconsiderations, retro authorizations, and appeals
- Notate account and update action codes in Artiva & Cerner Software for a total average of 60-80 claims worked per day exceeding position metrics goals (KPIs)
Bottom Line Systems
Lead Hospital Claims Analyst
05.2018 - 04.2020
Job overview
- Billed UB-04 and HCFA-500 claim forms electronically via billing software/clearinghouse, carrier portal entry/upload, and paper for Medicare, Medicaid/Medi-Cal, Commercial, Workers' Comp, and Auto carriers
- Worked rejected claims due to invalid patient demographics, billing coding/charge entry errors
- Contacted insurance companies by phone, email, or online portal to follow up and confirm receipt/status of claims, obtain payment info/denial reason
- Analyzed complex Explanations of Benefits to work denials and verify copay/coinsurance /deductibles, insurance allowable, and contractual adjustment
- Examined catastrophic high-dollar claims and calculated reimbursement based on insurance payor contract terms to identify Stop Loss, DRG, High-Cost Drugs/ Implants Carve-Out, and Underpayments per carrier contractual agreements
- Prepared, and pulled medical records from PowerChart to submit along with provider disputes/reconsiderations, retro authorizations, and appeals
- Noted claim in Cerner for a total average of 80-100 claims worked per day exceeding position metrics goals (KPIs) and individual monthly cash goal of $250k
- Completed month end and accounted for total cash/offsets and adjusted balance for claims where all collection efforts had been exhausted
- Trained and onboarded new hires for their first 120-days of employment to ensure employee/employer success
- Completed monthly quality assurance audits for clear/concise notes, policy/procedures, and compliance
- Created, maintained/updated training manuals for new hire training and company policy and procedures
Proficient Revenue Cycle Solutions
Medicaid/Medicare Biller
06.2016 - 05.2018
Job overview
- Completed Monthly Billing of Primary/Secondary skilled nursing /long-term care claims for Commercial, Medicaid MCO, Medicare Advantage, Work Comp & Auto Carriers for the following states: Florida, Kansas, Idaho, New Mexico, Nebraska, Montana, Arkansas, Missouri
- Worked Accounts/Receivables, Credits, and Refunds for multiple Skilled Nursing & Long-Term Care Facilities via (PCC-Point Click Care, AHT- American HealthTech, Paper, Direct Entry/Upload via Payer Portal)
- Worked claim edits, eligibility, and coding rejections via Zirmed of UB-04 & HCFA forms (Reviewed Insurance Verification/ Fee Schedule/Contracts to confirm expected reimbursement, Revenue, Diagnosis Codes, Occurrence, Value Codes, & Bill Type)
- Submitted Reconsiderations & Appeals of denials for untimely filing and pre-certification/pre-auth denials
- Worked directly with Business Office Manager/Assistant of 20 Facilities and exceeded cash goals ranging between $800k-$1.5 million monthly
Adventist Health System
Claims Examiner
05.2012 - 05.2016
Job overview
- Performed Data Entry and Claims Validation of HCFA-1500 & UB-04 claims using ICD-9/10, CPT/HCPCS, and revenue codes to be processed for payment in a timely manner
- Repriced claims and reviewed accuracy of claims including diagnosis, prior history, and services rendered
- Managed benefit determination such as copay, co-insurance, deductible, and plan maximums
- Ensured that all claims, both on paper and electronic were processed, and analyzed in an accurate and timely manner
- Facilitated prompt payment to providers of approved claims
- Collaborated with claims department and industry anti-fraud organizations to resolve claims
Education
Corithian CollegeMiami, FL
Associate from Clinical/Medical Assistant
Skills
- Revenue Cycle Management
- Accounts Payable and Accounts Receivable
- Health Information Management
- Data Analysis
- Medicare and Medicaid Processes
- EMR/EHR (Cerner, Epic)
- Excellent Communication
- Organizational Skills
- Problem Solving
- Time Management
Certification
- Certified Revenue Cycle Representative (CRCR), Healthcare Financial Management Association (HFMA) - Issued Jul 2021 · Expires May 2024
Availability
See my work availability
Not Available
Available
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Certified Revenue Cycle Representative
Signature Performance
04.2020 - Current
Lead Hospital Claims Analyst
Bottom Line Systems
05.2018 - 04.2020
Medicaid/Medicare Biller
Proficient Revenue Cycle Solutions
06.2016 - 05.2018
Claims Examiner
Adventist Health System
05.2012 - 05.2016
Corithian College
Associate from Clinical/Medical Assistant
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