Grace R. Email and Phone Number
With 30 years of dedicated experience in the healthcare industry, I provide a suite of essential services designed to enhance operational efficiency and optimize financial performance for healthcare organizations. My expertise encompasses several critical areas, ensuring that providers can focus on delivering quality patient care while I handle the complexities of revenue management and enrollment processes.### Provider Enrollment SpecialistNavigating the intricacies of provider enrollment can be a daunting task for many healthcare organizations. I bring three decades of experience in handling the enrollment process with precision. From completing applications to verifying credentials and managing ongoing updates, I ensure that providers are enrolled with insurance payers quickly and efficiently. My deep understanding of various payer requirements allows me to minimize delays, ensuring that providers can start billing for services sooner.### Revenue Cycle SpecialistEffective revenue cycle management is vital for the financial health of any healthcare organization. I specialize in streamlining the entire revenue cycle process—from patient registration and charge capture to claims submission and payment posting. My goal is to reduce days in accounts receivable and enhance cash flow by identifying and addressing bottlenecks. With my strategic approach, I implement best practices that increase revenue and minimize denials.### Follow-Up and Denial ManagementFollowing up on unpaid claims is crucial for maintaining a healthy revenue stream. I offer dedicated follow-up services to track outstanding claims and resolve issues with insurers promptly. By employing effective denial management strategies, I identify the root causes of claim rejections and work towards rectifying them. My thorough analysis ensures that denials are reduced and payments are maximized, allowing healthcare organizations to recover lost revenue.### Billing SpecialistBilling is the backbone of the revenue cycle, and accuracy is paramount. As a billing specialist, I manage all aspects of the billing process, including claims preparation, submission, and reconciliation. My meticulous attention to detail ensures that billing errors are minimized, and compliance with regulations is maintained. I stay updated with coding changes and payer policies, ensuring that your organization remains compliant while maximizing collections.
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Enrollment SpecialistSt. Luke'S University Health Network Aug 2023 - PresentAllentown, Pennsylvania, United States-Provider Enrollment: Manage the end-to-end enrollment process for healthcare providers, including gathering necessary documentation, completing applications, and submitting them to appropriate health plans.- **Verification and Compliance:** Ensure that all provider credentials and documentation meet regulatory and contractual requirements. Conduct regular audits to maintain compliance with enrollment standards.- **Communication:** Serve as the primary point of contact for providers during the enrollment process. Communicate effectively to address questions and resolve any issues that may arise.- **Data Management:** Maintain accurate and up-to-date records in the enrollment database. Ensure that all information is documented according to company policies and procedures.- **Collaboration:** Work closely with internal teams such as credentialing, compliance, and customer service to streamline the enrollment process and improve provider experience.- **Training and Support:** Provide training and support to new providers on the enrollment process and use of electronic systems.- **Reporting:** Generate and analyze reports on enrollment statistics and trends to identify areas for improvement and inform leadership. -
Revenue AnalystCaduceushealth® Oct 2008 - Aug 2023United States -
Data AnalystCaduceushealth® Oct 2009 - Jun 2023Jersey City, New Jersey, United StatesProvided project-level analysis and produced required project analysis documentation.Recommended controls by identifying problems and writing improved procedures.Updated company's database daily with new details regarding collections and activity on delinquent accounts.Prepared technical reports by summarizing, collecting and analyzing trends.Received and submitted payments, updated account information and provided receipts.Analyzed and synthesized business requirements by conceptualizing processes and recognizing Designed new computer programs by analyzing requirements and constructing workflow charts and diagrams.Prepared administrative reports and assembled case files for closure.Interacted with clients and insurance representatives to collect on delinquent accounts and secure late returns.Checked completeness of information when processing applications and transactions.Trained staff and users to work with computer systems and programs.Troubleshot program and system malfunctions to restore normal functioning.Set up and monitored payment plans and processed payments.Examined accounting systems and records to determine appropriateness of methods and controls.Developed and managed project plans while providing status updates to management.Developed, documented and revised system design procedures and quality standards.Tested, maintained and monitored computer programs and systems.Assisted staff and users with computer malfunctions and program problems.Used computer in analysis and solution of business problems.Conferred with clients regarding information processing or computation needs.Expanded or modified system to serve new purposes or improve workflow.Maintained quality-focused performance benchmarks and schedules when directing project teams.Coordinated and linked computer systems within organization to increase compatibility to share information -
System AnalystCaduceushealth® Oct 2008 - Jun 2023 -
Client Relations SpecialistCaduceushealth® Oct 2008 - Jun 2023United StatesAdjudication of claims to insurance companies and researched and resolved denials and explanations of benefit rejections.Answered customer invoice questions and resolved issues discovered during invoicing and collection process.Contacted insurance providers to verify insurance information and obtain billing authorization.Worked with team members and leadership to identify and develop process improvements.Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.Completed billing audits in identified timeframes to report and investigate findings.Performed data import, scanning or manual keying processes to verify accuracy.Reviewed vendor documentation to comply with payment guidelines.Assessed billing statements for correct diagnostic codes and identified problems with coding.Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.Presented status updates and workflow recommendations to senior management.Participated in revenue cycle processes, working to maximize profitability,Monitored revenue status and created detailed reports for senior management.Detailed key revenue cycle information thorough presentations to deliver to executives and management team. Identified and corrected payment problems involving patients or third-party payers.Developed financial analysis reports and presentations by applying financial principles.Supported customers having data connectivity issues, assisting with troubleshooting steps and rebooting of hardware.Troubleshot daily IT desktop client issues,Assisted customers by troubleshooting and resolving technical problems.Managed user profiles, security access and shared file structures.Trained new employees.Reviewed support cases for technical and troubleshooting accuracy.Delivered on-site technical support following software implementation and worked to suggest product upgrades and changes. -
Revenue Cycle ConsultantMontefiore Medical Center Jan 1999 - Oct 2009Bronx, New York, United StatesReview and manage all aspects of collections research and correspondence with insurance companies, physicians, clinics, and hospitals timely and accurately to retain payments for unpaid and underpaid insurance claims. Account Receivable/Payable reporting and audits.Update yearly fee schedules, based on insurance contractual agreement.Maintain and update system dictionaries and general maintenance. Provide reports to clients for open A/R - Implementation and trainer.Claim processing to ensure timely turn round.Create user security accessResolve user issues within billing systemAnalyze, log, track and complex software and hardware matters of significance pertaining to networking connectivity issues, printer, server, and application to meet business needsReport and research connectivity issues. Customer Service for all clientsInbound and outbound calls. Established and implemented guidelines for medical providers to ensure data accuracy. Coordinated billing for patients, routing them to patients and insurance companies Resolved billing issues and disputes in a timely manner.Monitored EFT and lockbox payments denials and correspondence. Monthly and weekly training of new and existing staff. Liaison between provider and billing office.Contacted insurance providers to check patient coverage.Completed weekly account reconciliations to identify discrepancies.Produced accounting reports and provided targeted recommendations for improving revenue standing.Assessed requisitions each month to ensure accuracy and reconciled transactions.Built and strengthened client relationships to form long-lasting, profitable bonds.Evaluated financial and operational performance of companies facing financial difficulties. Reviewed costs, expenses and revenue Utilized financial analysis to prepare plans of action.Developed financial analysis reports and presentations by applying acquired financial principles. -
Revenue SpecialistMontefiore Health System Jan 1999 - Oct 2008Bronx, New York, United States
Frequently Asked Questions about Grace R.
What company does Grace R. work for?
Grace R. works for St. Luke's University Health Network
What is Grace R.'s role at the current company?
Grace R.'s current role is Enrollment Specialist St Luke’s University Health Network.
Who are Grace R.'s colleagues?
Grace R.'s colleagues are Harold Mason, Carter Edmiston, Alexandra Casseus, Mohammed Qahash, Tracy Ader, Cynthia Yeboah, Doreen Kleca.
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