VANESSA GRIGGS
Apopka,FL
Summary
Customer service oriented professional who provides timely and accurate data to ensure reimbursement for patient services. Follows policies, procedures and guidelines to assure consistent quality. Maintains and ensures patient privacy and confidentiality. Regarded as a loyal and competent employee as evidenced by a dedicated work history.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Referral Coordinator 2
Humana Military
09.2022 - Current
- Recognizes a sensitive diagnosis and/or referral requiring Case Management and pend to appropriate point of contact for review
- Requires assigning appropriate ICD10 code to referral as well as appropriate CPT Code
- Decisions are typically focus on interpretation of area/department policy and methods for completing assignments
- The Referrals Coordinator 2 includes data entry into medical management system, assigning an appropriate provider, reviewing for benefits, and/or medical necessity as required or pending to a nurse or supervisor who can complete or request additional information
- Answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referral
Referral Coordinator
Optum
10.2015 - 09.2022
- Professionally handling all front desk operations, including answering phones, greeting patients, scheduling of the appointments, balancing daily collections
- Ensured the office operated efficiently
- Processed appropriate authorization for HMO/PPO clients as specified in the HCP procedures
- Assist and monitor the processing of all referrals
- Processed referrals for durable medical equipment and coordinated home health services according to established policies, procedures, and guidelines
- Processed elective surgical requests including the coordinator of surgery dates notification of inpatient team, Hospitalists or Care Manager
- Coordinates, identifies and routes referrals that require review to licensed Care Management staff who arranges outside physician medical review as appropriate
- Work with patient services regarding patient concerns
- Collect and prepare medical records for review when appropriate or as requested
- Proficient in Allscripts EHR, Allscripts PM, HMS, Availity, Focus, ECW, Allscripts, Epic, Tricare, Careplus, Freedom, RMS, Excel, Microsoft
Production Scheduler / Office Manager
T.G. Lee Dairy
10.2008 - 12.2013
- Managed inventory levels, maintained accurate reports, identified potential product issues, and communicated appropriately between departments
- Ensured the office operated efficiently
- Loaded and unloaded material from trucks into predetermined areas or onto shelves
- Staged materials and pulled orders according to assigned route within the warehouse
Education
Associate of Science - Medical Billing and Coding
Ultimate Medical Academy
Tampa, FL12.2014
Skills
- Co-Payments & Deductibles
- Electronic Medical Records
- ICD10 coding
- Medical Records Management
- HIPAA
- Medicare
- Referral processing
- Medicaid
- Attention to detail
- TRICARE
- Customer service
- United Healthcare
- Multi-line phone proficiency
- Humana
- HIPAA regulations
- EOBs
- Epic systems
- Managed Care
- Electronic Payment Posting
- Appointment Scheduling
- Allscripts EHR
- Allscripts PM
- HMS
- Availity
- Focus
- Onbase
- MSR
- ECW
Certification
Medical Billing Specialist, 04/2024
Timeline
Referral Coordinator 2
Humana Military
09.2022 - Current
Referral Coordinator
Optum
10.2015 - 09.2022
Production Scheduler / Office Manager
T.G. Lee Dairy
10.2008 - 12.2013
Associate of Science - Medical Billing and Coding
Ultimate Medical Academy
Similar Profiles
Lara WhiteLara White
Preauthorization Nurse at Humana MilitaryPreauthorization Nurse at Humana Military
Trevor RawleighTrevor Rawleigh
Software Engineer at Humana MilitarySoftware Engineer at Humana Military
DEIRDRE HART, RNDEIRDRE HART, RN
Utilization Review RN at Humana MilitaryUtilization Review RN at Humana Military