**** ******* ******

Nashville, TN *****

615-***-****

ad2z98@r.postjobfree.com

Keisha Griffin

Summary

Intelligent, consistent, responsible, and well-focused individual

Working toward expanding knowledge in a stable and progressive environment.

Willing to learn different tasks to broaden knowledge.

Experience

State of Tennessee Tenncare

Managed Care Specialist III

March 2021-February 2023

Reviewed cases for Medicare coverage for single families depending on family size and income and also for individuals that were over the age of 65. Ran eligibility to make sure if they were eligible for Medicare or denied.

Woodbine Health Department

Front Desk Clerk

June 2020-March 2021

Checked in patients at the front desk. Verified insurance and updated demographics if needed. If patients did not have health insurance verified income and placed them on a sliding scale to pay for

services rendered on that day and any other outstanding balances.

Centerstone Behavioral Health

Client Accounts Receivable

March 2019-May2020

Worked on clients with Americhoice Medicaid Insurance. Worked on different

spreadsheets. Denials, On Account Balances, Unmatched, Refunds for

overpayments to the insurance company.

Vanderbilt University Medical Center

Denials Specialist

March 2018-February 2019

Worked backlog denials from various payers/system issues due to Epic go-live

for CMS-1500 claim follow up. Following up with commercial, Medicare,

and Medicaid insurances. Working appeals, denials, and adjustments. Requested

modifiers to be added where needed for reimbursement. Calling payers to check on

denial status. Working online payers to check on websites and manual payer forms.

Completed tasks for redeterminations and reviewing of claims.

Jackson Clinic PA

Patient Representative/Insurance Claims Processor

May 2014-March 2018

Patient Representative

Answered patient calls about account balances,took personal payments over

the phone. Worked accounts that needed to be reported to collections. Updated

demographics. Sent letters to patients if the account was 60, 90, or 120 days

late. Once promoted to Insurance Claims Processor description of duties are as follows

Insurance Claims Processor

Work patient’s accounts that have United Healthcare, Tricare, United Medical

Resources, and Humana Insurances. Worked claims for with timely filing, if

additional information was needed from the patient or provider. Also correct claims add

modifier, changed diagnosis after review of the doctors dictation to get claims reprocessed and or paid.

Terrace Pediatric Group

Medical Biller

October 2004-May 2014

Post private payments to personal balances, post insurance payments to

claims, also ten key upon other medical computer skills.

Work collections for patients 60-120 days delinquent on accounts.

Work insurance claim rejections, denials, and call insurance companies to

investigate reasons for denials and refile claims if needed.

Receptionist duties, included working front desk, check in patients, verify

insurance, schedule appointments, and multiple phone tasks. HIPPA knowledge.

Education

Internship Matthew Walker Comprehensive Clinic 2004

Nashville, Tennessee

Draughons Jr College

Associate Degree Health Information Technology

Concentration : Medical Billing and Coding

Nashville, Tennessee

Concentration on Professional Communications, and Medical Software Operations.

Medical Computer literate, Microsoft Word and Works, Microsoft Office, ICD-10,

ICD-9, all CPT coding. Medicare Part A and B, Private Insurance Claims, Patient

Accounts, Patient Collections, 10 Key. Medically organized and of solid work

ethics.

Reference Upon Request

Interests Caring for other individuals and helping others with hand on experience. And

to learn from others or teach others different skills within the medical or general

fields.

Medical Software Credentials

Acardia

Aprima

Athena Health

AllScripts

Epic

eClinicalWorks

NexGen Healthcare

Cerner

EpicCare EMR

Optum

KIPO

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