Amanda Graves
About
Detail
Experienced RCM Account Manager and Medical Billing Specialist
Greenville, Texas, United States
Résumé
Jobs
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Reimbursement SpecialistLingraphicaDec 2024 - Apr 2025 (5 months)Responsible for overseeing the reimbursement processes for Lingraphica’s products and services. Oversee the end-to-end reimbursement process, including payer correspondence, claim submissions, follow-ups, appeals, and denials management. Ensure timely and accurate billing to private insurers, Medicare, Medicaid, and other payers. Develop and implement strategies to optimize reimbursement rates and reduce claims denials. Monitor reimbursement trends, payer policies, and regulatory updates to ensure compliance. Identify opportunities for workflow improvements by collaborating with internal teams to streamline reimbursement processes. Provide training and guidance to team members on reimbursement best practices and policies.- Senior Reimbursement SpecialistLingraphicaDec 2024 - Mar 2025 (4 months)
- Claims AnalystLumerisOct 2022 - May 2024 (1 year 8 months)Analyzed and resolved complex issues for paper and electronic claims, ensuring accuracy and compliance with relevant regulations. Ensured accurate and timely claims. Produced detailed reports for management, highlighting status and insights on current and processed claims. Calculated manual pricing for claims and adeptly coordinated benefits, including adjustments to copayments, coinsurance, and out-of-pocket maximums. Collaborated with internal departments to reduce manual calculations and automate several claim processing procedures. Provide training, coaching and mentoring to ensure consistency in QA/Productivity and to ensure Team goals and objectives are achieved monthly
- Revenue Cycle ManagerTherapy BrandsDec 2020 - May 2022 (1 year 6 months)Managed client satisfaction by coordinating and delivering Revenue Cycle Management services, ensuring efficient claim submissions, and handling denials, rejections, corrections, and appeals. Developed and implemented measurable metrics to monitor and assess client performance, contributing to enhanced service delivery. Produced detailed reports and action plans, facilitating transparent communication and strategic planning with clients. Assisted with the daily distribution of workload. Identified opportunities for improvement and increased efficiency. Supported clinics in resolving revenue cycle issues and fostered strong relationships with physicians, assisting with comprehensive claims management.
- Senior Claims AnalystCignaNov 2011 - Jul 2020 (8 years 9 months)• Responsible for researching, investigating, and paying medical and hospital claims in a timely manner.
• Meeting quality and production goals and managing priorities and time wisely.
• Investigating coordination of benefits and member details as well as, the ability to interpret coding guidelines, CMS regulations, reimbursement, Medicare Claim Processing for accurate application of policy to claim edits and audits.
• Research coding and fee schedule questions supporting various departments.
• Serve as a Subject Matter Expert (SME) with proven ability to effectively communicate with all levels of the organization.
• Proficiency in medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract conce - CEnvironmental Services ManagerChildrens Medical CenterOct 2010 - Oct 2011 (1 year 1 month)Supervisor over Environmental Services department, scheduling employees work schedules, maintaining cleanliness and sanitization of hospital.
Education
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- Bachelor's degree, EDUCATIONTexas AM UniversityCommerceJan 2003 - Dec 2005 (3 years)Bachelor of Science degree in Kinesiology with a Minor in Health.