Jen Grimes, Cpc Email & Phone Number

Franklin, Tennessee, US

Franklin, Tennessee, US

• Conduct in-depth analysis of multiple datasets, including claims and patient data. Utilizing data mining, data validation, and querying to identify and interpret trends. Provide monthly trend report and actionable.
• Lead a team of 19 Certified Nurse MDS Coordinators/Trainers/Auditors and Certified Billing Coders
• Developed a training manual for facility based MDS Coordinators
• Increased Medicare PDPM Revenue in the SNF Division by $1.2 Million in the last twelve months
• Increased Medicaid CMI Revenue in the SNF Division by $2 Million in the last two quarters
• Decreased ADR Risk across multiple divisions by $12 Million in the last year

Franklin, Tennessee, US

• Oversee and implement processes, procedures, and monitor performance to ensure legal, ethical revenue capture; accurate MDS documentation; and reimbursement retention for Skilled Nursing Facilities, Unity Geriatric.
• Developed PDPM Data Trend Analysis Reporting and recommendations for actionable items to improve Revenue Capture, Reimbursement, and Clinical Documentation Compliance
• Developed ADR Trend Reporting
• Implemented focus reviews of Medicare Part B claims for the Rehab Division
• Member of Compliance Committees for all lines of business (7) and American Health Partners

Chicago, Illinois, US

• Responsible for maximizing the collection of medical, dental, & behavioral health services payments and reimbursements from patients, insurance carriers, financial assistance, and guarantors.
• Responsible for evaluating, reviewing, and implementing all policies and procedures related to insurance eligibility processes, charge processing, claim submission and processing, payment processing, collections and.
• Hire, train, supervise, and evaluate: 1) Directly; the Manager of Revenue Cycle and the Manager of Access & Enrollment 2) Indirectly; A/R Specialists, Patient Enrollment & Access Specialists, Registration, and.
• Oversight of all business-related functions of the patient visit from point of entry to accurate adjudication of the patients’ account.
• Develop and make recommendations on information analyzing claims, utilization, and medical cost data and prepare monthly statistics..
• Oversee the maintenance of enrollment rosters and empanelment services.

Claim ADRsReview clinical documentation to respond to claim ADRs, HEDIS Audits, Medicaid Audits and appealsIdentify issues causing claim ADRs and AuditsTrain facility staff on more efficient systems to accurately document care provided. Updated claim ADR and Audit submission processes to align with HIPAA standards. Triple Check Process TrainingEducate.

Skokie, Illinois, US

• Lead a team that encompasses Corporate Physician Billing/Coding Coordinator, Business Office Managers, Accounting Clerks & SNF Medicare Billing/Coding coordinators. Provide concierge-level customer service and engage.
• Implement & manage Medicare Compliance program for all Life Care Community (LCC) Campuses and Outpatient Therapy Clinicso Audit Medicare, Medicare Advantage, Medicaid, & Insurance claims for regulatory compliance and.
• ICD-10 Training and Implementation at all LCC Campuses & Outpatient Therapy Clinics
• Responsible for billing & collecting approximately $120M annuallyo Ensure the following: therapy logs meet requirements for MDS reimbursement RUG, campus census documentation supports the dates of service on claims.
• Create quarterly presentations for the Corporate Compliance Committee with detailed statistics and data analysis indicating the effectiveness of our billing compliance programs and the implemented adaptations for.
• Complete & maintain credentialing for Physicians & Nurse Practitioners

• Managed a group of 7 Medical Billing Specialists/Coders
• Completed and maintained credentialing for 11 physicians
• Supervised billing for 6 clinics, physician hospital rounds, nursing home visits, and home health certifications
• Managed the implementation of new EMR program at 2 clinics (eClinical Works)

• Managed billing for 17 medical practices with over 50 medical providers
• (Family Practice, Physical Therapy, Pain Management, Social Worker, Psychologists, Psychiatrists, Chiropractors)
• Completed and maintained Provider Credentialing with CAQH, insurance companies, and hospitals
• Negotiated billing contracts with medical providers as prospective clients
• Client meetings to ensure that CMBS was providing exceptional customer and billing services
• Trained/Supervised billing, insurance verification, and credentialing employees