AG

Arlena Griggs

Provider Enrollment Specialist II-July 2022-Present

Envision Healthcare

May work with highly diverse and/or complex client sites and payors; provide guidance to other Enrollment Coordinators, and act as resource or expert for others to assist in training and problem solving.

Participate in establishing, implementing, and monitoring of enrollment guidelines. Work with team members to explain processes and tracks performance and adherence to guidelines to ensure department and individual success.

Following established enrollment procedures and sound practice directly or by working with Enrollment Coordinators, prepare applications for all new providers for multiple contracts sites, payors and states requiring an acute attention to detail, accuracy, and knowledge of complex and varied requirements. Review applications for completeness, flag missing information and signatures before sending the pre-populated applications to the providers for completion. Track and follow up on a timely basis to ensure completion of application process and submission to payor for approval.

Extensive and frequent verbal and written communications with Clinicians, state payors, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities. Act proactively and build strong relationships with payors to facilitate enrollment and obtain provider billing numbers.

Work with in-house and third-party Billing Company for current applications, system updates and identifying/resolving problems. Handle corrections or rejections of claims due to enrollment errors and/or claim submission requirements. Convey issues and status of problems to Enrollment Management. Ensure Held A/R enrollments are submitted on a timely basis to avoid risk of claims/adjustments and an unnecessary increase of Held AR. Maintain and work reports of non-compliant providers and held A/R to maximize income opportunities.

Accountable for meeting or exceeding divisional and/or corporate Enrollment performance standards and meeting time-sensitive deadlines as defined. Update status of application in system databases and in Excel reports for accurate reporting.

Work independently within the scope of responsibility and authority. Understand and follow state and payor requirements, some of which are quite complex, and determine which applications require management approval or special processing requirements. Able to work with high volume enrollments while multi-tasking and driving provider enrollments through completion. (example: 10 contracts with 40 providers per contract).

Hospitalist Coordinator October 2011-2022

ER/Urgent Care/ Billing Coordinator - Katy, TX

•Review and scan physician charts to ensure completion of all documentation which includes but not limited to applicable patient progress notes, Physicians orders, patient demographics, patient insurance information, dictations, and MD signatures

•Perform daily data entry of all physician chart information for billing purposes

•Generate unbatched discharged reports to ensure any unbatched charts are identified and submitted to RTI for billing

•Facilitate meetings with ER Site Medical Director and Client Services Manager to address any compliance or quality assurance issues stemming from Physicians lack of documentation or missing information

•Assist hospital and RTI personnel with billing inquiries, reconciliations, and resolving complaints related to patient charges

•Assist with distribution and communication of physician work schedules

Boys and Girls Club September 2022-Feburary 2023

Youth Development Coordinator

Plan and conduct educational and recreational programs in a School Based Club.

Help youth with homework and tutor, run games, and drop in activities

Develop educational programs that are stimulating and age appropriate for all members.

Provide an environment that promotes creativity and exploration through learning.

Safeguard the confidentiality and safety of all members.

Promote and stimulate membership in the department ensuring that every Club member participates in some Learning Center activities.

Understand and communicate to youth the importance of doing well in school and having a plan for going to college, vocational school, or entering the workforce at age 18.

Support site in taking program attendance daily for programs.

Work with volunteer tutors and students to participate in an ongoing education improvement program.

Quality Control Specialist 2009-2010

US Census Bureau - Bay City, TX

•Maintained database updating address maps

•Performed daily data entry

•Conducted daily interviews with respondents

•Created periodic and cost reports at supervisor request

•Maintained team payroll records which included hours worked, time driven, and additional expenses incurred while performing duties

Child Care Specialist 2008-2009

Financial Aid - Bay City, TX

•Assisted clients with completing job applications to ensure they found gainful employment and/or scholarships to aid in skill enhancement to obtain better employment

•Performed daily data entry while obtaining, verifying, and calculating client's current income or resources to determine eligibility for childcare

Unit Administration Secretary 2005-2008

Texas Department of Family and Protective Services - Wharton, TX

• Answered incoming calls for entire staff

• Maintained all meeting minutes

• Prepared travel vouchers for case workers

• Performed daily data entry regarding client in-take information for referral to case worker

• Maintained database of statistical reports, case records, and personnel records

• Provided staff with technical support on software issues, equipment issues, and reordered supplies as needed

• Maintained record of staff time, leave, and other duties as requested

Customer Service Representative 2004-2005

Northland Cable Television - Bay City, TX

• Retrieved and processed mail payments

• Performed in-house transactions

• Answered incoming calls

• Scheduled new service installations

• Performed other office duties as needed or requested

Secretary II for Project Rio 2000-2003

Texas Department of Criminal Justice- Rosharon, TX

• Performed offices duties such as filing, data entry, answered incoming calls, and ordered supplies as needed

• Scheduled monthly interviews for employment

• Scheduled inmate visitations with their families

• Prepared monthly reports for Assistant Warden per request

• Maintained Assist Warden monthly calendar

• Maintained inmates trust funds

• Assisted with preparing litigation files

• Assisted inmates with completing job applications for the Work Source upon being released from incarceration

Education

Lake Jackson TX-Brazosport Jr. College 1984-1986

Business Administration Brazosport Jr. College

Angleton, TX

281-***-****

adw0wh@r.postjobfree.com

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