THERESA GRAFFLIN
Canton,TX
Summary
Experienced healthcare accounts receivables professional with extensive knowledge in Medicaid, Medicare, Military, and Commercial payers. Trained in Six Sigma for Electronic Data Interchange, I have a deep understanding of clearinghouse dynamics and processing. Expertise in managing and optimizing the revenue cycle for accurate and timely reimbursement of healthcare services. Proven success in streamlining processes and maximizing financial outcomes for healthcare organizations.
Overview
10
10
years of professional experience
Work History
Revenue Cycle Specialist
Conifer Health Solutions
01.2017 - Current
- Increased revenue by identifying and resolving billing errors in a timely manner.
- Trained new team members on revenue cycle best practices, contributing to a more knowledgeable workforce.
- Served as a liaison between clinical departments, finance, and administration, ensuring smooth communication for proper revenue cycle management.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Reached out to insurance companies to verify coverage.
Claims Auditing - Admin
Optum (previously Change Health)
01.2017 - 01.2025
- Reported post auditing reports for clients
- Validated data for auditing client coding
- Streamlined auditing process with automated worksheets
- Streamlined the audit process for increased efficiency through thorough organization and preparation of required materials.
- Validated accounts receivable and payable balances, ensuring accurate representation of company finances in reports.
- Reduced time spent on manual data entry tasks by implementing automated systems that increased productivity levels within the auditing department.
National HEDIS Reviewer
Centene (Ambetter, Healthnet)
01.2015 - 01.2017
- Managed High Volume IB/OB calls for Medicaid (various States)
- Spearheaded several Company-wide projects (client related)
- Streamlined auditing process with automated worksheets
Accounts Payable Specialist
DXC Technology
01.2015 - 01.2017
- Ensured timely payments for all invoices, maintaining strong relationships with vendors and suppliers.
- Processed invoices and journal entries with efficiency and accuracy, resulting in decreased discrepancies.
- Maintained compliance with internal controls and external regulations related to accounts payable processes.
Education
Bachelor Of Arts - English
Texas A&M University
College Station, TX06.1992
Skills
- Revenue Cycle Experience
- Billing and Auditing of Claims
- Electronic Data Interchange (EDI) Rejections
- Follow up and Reconciliation
- Communications
- Work with Clearinghouses and payer
- Led training to grow expertise on Team
- In-depth experience with RCM Applications
- Extensive knowledge of 100s of Payer Portal Operations and Protocals (Governmental and Commercial)
Timeline
Revenue Cycle Specialist
Conifer Health Solutions
01.2017 - Current
Claims Auditing - Admin
Optum (previously Change Health)
01.2017 - 01.2025
National HEDIS Reviewer
Centene (Ambetter, Healthnet)
01.2015 - 01.2017
Accounts Payable Specialist
DXC Technology
01.2015 - 01.2017
Bachelor Of Arts - English
Texas A&M University
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