Tiffany Graves
Las Vegas,NV
Summary
Team Leader experienced in directing activities of workgroups. Develops strategies, provides training, sets goals and obtains team feedback. Excellent interpersonal and communication skills. Big picture focus with excellence in communicating goals and vision to succeed. Problem solver, networker and consensus builder.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Team Lead
West Coast DME And Supplies
01.2018 - 11.2020
- As team leader the need to have their eyes and ears on the ground and always paying attention, is to oversee staff performance
- Monitoring front staff performance to ensure they meet daily goals, verifying individual performance by using tracking systems; coaching team members to improve performance.
Front Desk /Check-Out Specialists
- Checking in patient while verifying patient demographic for accuracy; Protect the security of medical records to ensure that confidentiality is maintained; scanning insurance and Id cards; Data entry; Obtaining patient authorizations, referrals and diagnostic reports when applicable; verifying patient insurance; Preparing physician schedule for the next day's appointments; Checking patients out posting correct CPT or ICD 9/10 codes for correct billing; Collecting patients balance, surgery deposit, co pay's or co-insurance; scheduling and canceling appointments; scanning patient paperwork
Care Review Processor
PIONEAR Staffing
08.2022 - 11.2022
- Provide computer entries of authorization request/provider inquiries by phone, mail, or fax
- Verify member eligibility and benefit, determine provider contracting status and appropriateness, determine diagnosis and treatment request, assign billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes), determine COB status; Verify inpatient hospital census-admits and discharges, perform action required per protocol using the appropriate Database
- Respond to requests for authorization of services submitted to CAM via phone, fax and mail according to Molina operational timeframes
- Participate in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long-Term Care
- Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director
- Provide excellent customer service for internal and external customers
- Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores
- Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status
- Meet productivity standards
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Participate in Care Access and Monitoring meetings as an active member of the team
- Meet attendance guidelines per Molina Healthcare policy
- Follow Standards of Conduct guidelines as described in Molina Healthcare HR policy
- Comply with required workplace safety standards.
ROI Specialist
ROI-Vchart
04.2022 - 07.2022
- Responsible for maintaining all the data of our healthcare facility; Data Entry/ Gathering medical data; Checking data for accuracy; Maintaining the privacy of patients' medical history by only providing on requested / signed authorized records
- Releasing information to other medical professionals; Copy, Scan, invoice and mail copies of medical charts per requests
- Provide quality work and perform quality assurance on all requests for medical records; Organize process, package and transmit work as provided in VRC guidelines
- Review client hospital and VRC policies for assigned tasks: Interface with Operations Supervisor and/or Manager as required; Participate in and attend training sessions or meetings as required.
Billing Team Leader
West Coast DME and Supplies
01.2018 - 09.2021
- Billing Team leader and Durable medical equipment biller- As a biller reliable, punctual and hard working
- Keeping all accounts in order
- Making sure all required paperwork needed to bill is clear
- Following up on claims with effective communications and ability to successfully address insurance companies; customers when needed
- Lead, fulfill all supervisory duties as required
- Prepare required paperwork needed for Medicare audits
- Train with my colleagues; Contact patient, collect, and establish payment, Resolve aging collection activity
- Third-party payment review to determine reimbursement
- Pre-certification
- Claim submittal, Intake, accounts receivable
- Maintain patient records.
Patient Benefit Coordinator
Southeast Orthopedic Specialists
01.2012 - 11.2017
- Providing Surgical Estimation, collecting deposits, verifying patient insurance for surgeries and calling insurance companies to provider most accurate estimation; giving a clear understanding of what to expect prior to and after surgery; obtaining surgical authorization and getting all necessary documentation for tracking; explain patient balances such as deductibles, coinsurance, out of pocket, copays, providing billing statements with copy of EOB received
Customer Service Representative for Medicare Part D, AARP and United Healthcare
Tele Tech
02.2006 - 03.2010
- Greeted and responded to customers in a courteous and friendly manner that conveyed a willingness to assist; Answered multi-line phones, directed calls, and took messages; Maintained / updated filing, inventory, mailing, and database systems, either manually or using a computer; Communicated with customers, employees, and other individuals to answer questions, or explain information, take orders, and address complaints; Operated office machines, such as copiers, scanners, facsimile machines, voice mail systems, and personal computers; Received customer's payments by, check, credit cards, vouchers or debit cards; Completed work schedules, managed calendars, and arranged appointments; Reviewed files, records, and other documents to obtain information to respond to requests and resolved customer's issues; Helped customer make up their decisions with confidence when providing benefits and features of coverage
Education
Diploma - Medical Insurance Billing and Coding
Fortis College
04.2013
Skills
- BILLING
- CPT
- ICD
- DATA ENTRY
- MEDICAL RECORDS
- Customer Service Representative
- Payment Processing
- Charge posting
- Medical billing
- ICD-9
- Medicare
- Insurance verification
- Medical Coding
- EMR Systems
- Medical Collection
- Triage
- ICD-10
- Medical Office Experience
- Live chat
- Documentation review
- Contracts
- Human resources
- Medical Terminology
- HIPAA
- Patient Care
- Auditing
- Records Management
- CPT coding
- QuickBooks
- Epic
- Databases
- ICD coding
- Managed care
- Office experience
- Workers' Compensation
- Anatomy Knowledge
- Behavioral Health
- Phone Etiquette
- Medical coding
- Medical records
- Medical terminology
- Accounting
- EMR systems
- Front desk
- Customer service
- Anatomy knowledge
- Hospital experience
- Data collection
- Accounts receivable
- Leadership
- Supervising experience
- Records management
- EHR systems
- Pediatrics
- Performance Improvement
- Performance monitoring
- Coaching and Mentoring
- Customer Focus
Certification
Medical Billing and Coding, Present
Additional Information
Skills Acquired: Understand use of CPT-4 code book; Convert office procedures to CPT-4 code; Understand use of ICD-9-CM and 10 code book; convert diagnosis to ICD-9-CM code and 10 ; Medical records management; Financial systems and procedures; Medical terminology and abbreviations; Body systems and related diseases; Understanding medical specialties; Use of medical software for - Registering patients, Scheduling patients, Posting payments, Posting charges, Running reports, Billing patients and insurance; Typing and data entry; Understanding HIPAA regulations, Understanding encounter forms; Understanding HCFA-1500 form, Understanding EOB; Worker's Comp, Medicare Part B and Medicare Replacement; Durable Medical Equipment; Collection, Billing and Appeal process
Industry
Healthcare
Assessments
- Protecting patient privacy, Proficient, 01/01/22, Understanding privacy rules and regulations associated with patient records
- Medical billing, Proficient, 01/01/22, Understanding the procedures and forms used for medical billing
Personal Information
Work Permit: Authorized to work in the US for any employer
Timeline
Care Review Processor
PIONEAR Staffing
08.2022 - 11.2022
ROI Specialist
ROI-Vchart
04.2022 - 07.2022
Team Lead
West Coast DME And Supplies
01.2018 - 11.2020
Billing Team Leader
West Coast DME and Supplies
01.2018 - 09.2021
Patient Benefit Coordinator
Southeast Orthopedic Specialists
01.2012 - 11.2017
Customer Service Representative for Medicare Part D, AARP and United Healthcare
Tele Tech
02.2006 - 03.2010
Front Desk /Check-Out Specialists
Diploma - Medical Insurance Billing and Coding
Fortis College
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