Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

TRACI GRAM

Rickreall,OR

Summary

Vast experience in healthcare with medical billing, insurance verification, care management, patient care, customer service, and medical records. Detail-oriented Claims Processor knowledgeable about automated systems and variations in plan benefits. Resolves high number of claims with fast and accurate analyses. Dependable in using proper classifications and meticulous recordkeeping.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Claims Specialist II

Providence Health & Services
BEAVERTON, OR
06.2019 - Current
  • Verified insurance coverage and eligibility for services provided.
  • Reconciled discrepancies between the Explanation of Benefits statement and the submitted claim form.
  • Applied knowledge of coding systems such as ICD-10, CPT, and HCPCS to accurately process claims.
  • Analyzed data from previous payments made by the insurer in order to set appropriate payment rates.
  • Investigated complex cases involving multiple providers, services, or diagnoses.
  • Evaluated insurance claims to ensure accuracy and completeness of documents.
  • Assessed denials based on established criteria and procedures.
  • Accurately processed large volume of medical claims every shift.
  • Based payment or denials of medical claims upon well-established criteria for claims processing.

Home Services Liaison Team Assistant 2

Providence St. Vincent Medical Center
Portland, OR
08.2018 - 05.2019
  • I am currently working with Providence Home Services
  • My experience in Home services has been scheduling for all of the Providence Hospitals Liaisons in Oregon, using several different scheduling databases, Data entry, interacting with Care management for pt care plans, Home health referrals, and customer service
  • All our work is done in fast paced, high volume setting for pt care
  • Home medical equipment liaison, I process all HME for discharging pts for PSTV, PPMC, PNB, PWFH, and PMH

Providence Nurse Advice Line

Beaverton, OR
08.2017 - 01.2019
  • I have work with multiple phone lines in a high volume call center
  • PROV RN covers for more than 550 providers across the northwest
  • I take patient information, assist with prescription locations, and am a liaison between the doctor and the patient
  • As part of my job requirement I also do insurance verification and charting in EMR as well as EPIC.

Driver

Mid Columbia Bus Company
Forest Grove, OR
10.2016 - 06.2017
  • Driver for Mid Columbia and was responsible for over a hundred students as well as communication with parents.

Office Manager

Animal Medical Hospital
Ashland, OR
06.2002 - 09.2014
  • Managed the office staff, scheduling appointments for clients, after hours call service, scheduling staffing for the clinic, growth of a second business, and bills pay for the office.

One on One patient care under RN supervisor

Legacy Meridian Park Medical Center
Tualatin, OR
06.2007 - 05.2013
  • Worked as a CNA in ICU as well as Float to Emergency department to cover as needed
  • One on One patient care under RN supervisor
  • Managed a multiple phone line desk and patient placement system.

Patient care under RN supervisor, Float to Emergency

Medford, OR
05.2004 - 03.2006
  • Manage multiple phone lines
  • Patient care under RN supervisor, Float to Emergency Department as needed to cover for patient care and Front desk admitting
  • Scheduler for full staff of CNA
  • Assisted with Patient care at home after the post surgical procedure was done and they were discharged.

Skylark Assisted Living

Ashland, OR
06.2003 - 01.2004
  • Worked as a night CNA to assist patients in an Alzheimer's unit.

Education

associates - General

Portland Community College Cascade
Portland, OR
06.2014

some college -

Rogue Community College
Medford, OR
06.2004

Skills

  • FACETS CLAIMS PROCESSING
  • ICD9 & ICD10
  • CLEAR HEALTH & CIGNA
  • MEDICAL CODING
  • COORDINATION OF BENEFITS
  • MEDICAL TERMINOLOGY
  • HEALTHCARE
  • EMR
  • EXCEL
  • HIPPA
  • INSURANCE VERIFICATION
  • TIME MANAGEMENT
  • ICU CNA
  • CUSTOMER SERVICE
  • SCHEDULING
  • OFFICE MANAGER
  • MULTIPLE PHONE LINES
  • DATA ENTRY
  • HIGH VOLUME CALL CENTER
  • MICROSOFT WORD
  • HOME MEDICAL EQUIPMENT LIAISON

Certification

  • Licensed to sell health and life insurance in Oregon 2024

Timeline

Claims Specialist II

Providence Health & Services
06.2019 - Current

Home Services Liaison Team Assistant 2

Providence St. Vincent Medical Center
08.2018 - 05.2019

Providence Nurse Advice Line

08.2017 - 01.2019

Driver

Mid Columbia Bus Company
10.2016 - 06.2017

One on One patient care under RN supervisor

Legacy Meridian Park Medical Center
06.2007 - 05.2013

Patient care under RN supervisor, Float to Emergency

05.2004 - 03.2006

Skylark Assisted Living

06.2003 - 01.2004

Office Manager

Animal Medical Hospital
06.2002 - 09.2014

associates - General

Portland Community College Cascade

some college -

Rogue Community College
TRACI GRAM