Marlee Grimes
Gruetli-Laager
Summary
Efficient Claims Processor known for high productivity and task completion. Possess specialized skills in claims analysis, documentation verification, and regulatory compliance ensuring smooth operation flow. Excel in time management, problem-solving, and communication, leveraging these soft skills to effectively manage workloads and facilitate clear interactions with all stakeholders.
Overview
9
9
years of professional experience
Work History
Clinical Assistant
BCBST
08.2024 - Current
- Screen incoming faxes and load fax inquiries for incoming auth request
- Clearly document and key data into the appropriate system using departmental guidelines
- Key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process
Claims Examiner
BCBST
03.2023 - 08.2024
- Process medical claims in Facets and claims administration
- Pay/deny claims depending on Prior Authorization and benefits
- Key in benefit information
Office Manager/Insurance Coordinator
Signal Smiles Dental Studio
10.2021 - 03.2023
- Verify the patient’s dental insurance benefits
- Explain insurance benefits to patients
- Enter data using dental practice management software
- Post payments made by patients
- Follow up on non-paid insurance claims
- Managed late payments and overdue accounts
- Process insurance payments and refunds
- Process payroll
Office Assistant
CHI Memorial Surgical Associates
07.2020 - 10.2021
- Scheduled incoming referrals
- Input patient information into electronic record, following proper HIPAA
- Verified patient insurance benefits
- Collected co-pays and past due balances
Receptionist
Erlanger Health System
11.2019 - 07.2020
- Input patient information into electronic record, following proper HIPAA
- Verified patient insurance benefits
- Collected co-pays and past due balances
- Worked in satellite office at an Assisted Living facility
Receptionist
CHI Memorial Internal Medicine
06.2018 - 11.2019
- Input patient information into electronic record, following proper HIPAA
- Verified patient insurance benefits
- Collected co-pays and past due balances
- Processed patient referrals
- Worked in satellite office at an Assisted Living facility
Cooperative Response Center
11.2016 - 02.2018
- Answered phones in a call center
- Processed payments for electric companies
- Reported electric outages throughout the United States
Education
Associates of Science -
Motlow State Community College
GED -
Motlow State Community College
Skills
- Claims processing
- Patient documentation
- Insurance verification
- Electronic health records
- Healthcare compliance
- Benefit administration
- Customer service
- Data entry accuracy
- Problem solving
- Attention to detail
- Time management
- Patient confidentiality
- Document filing
- Medical terminology
- Insurance authorizations
- Knowledgeable in Microsoft Office
Timeline
Clinical Assistant
BCBST
08.2024 - Current
Claims Examiner
BCBST
03.2023 - 08.2024
Office Manager/Insurance Coordinator
Signal Smiles Dental Studio
10.2021 - 03.2023
Office Assistant
CHI Memorial Surgical Associates
07.2020 - 10.2021
Receptionist
Erlanger Health System
11.2019 - 07.2020
Receptionist
CHI Memorial Internal Medicine
06.2018 - 11.2019
Cooperative Response Center
11.2016 - 02.2018
Associates of Science -
Motlow State Community College
GED -
Motlow State Community College