ABOUT

Monica Grimmett, a Revenue Cycle and Healthcare Administrator Consultant, is a seasoned, results-driven professional with over 29 years of healthcare experience in a customer service capacity.  Ms. Grimmett has excellent problem-solving, project management, organizational and interpersonal skills with the ability to train and manage staff.  Well-organized and efficient in the planning and execution of managerial duties.  Proficient in a variety of practice management software applications.

 

Monica has worked as a billing office implementation specialist and provided the following services for clients:

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• Actively assists with the credentialing process for current and new physicians to the medical group.

• Creates Front Office and CBO Office workflow processes within the preferred EMR database to ensure successful revenue capture.

• Implement and train CBO staff members on effective coding and audit processes.

• Completes daily chart audits to ensure all charges have been captured for claim submissions

• Conduct weekly teleconference calls to discuss workflow processes, additional training suggestions and additional client concerns

• Recruit, screen and train medical administrative office employees

• Ensure compliance with personnel licensing and continuing education requirements for clinical personnel

• Provide training, coaching, mentoring and performance appraisal for administrative personnel

• Keep current with changes in employment and privacy laws, HIPAA requirements and other relevant laws and regulations as related to medical office operation

• Responsible and accountable to the Chief Medical Director for helping to manage health plan medical costs and assuring appropriate health care delivery for   health plans, products and services. Reports organizationally to the Chief Medical Director of the Health Plan; has a dotted line relationship to the Chief Medical Officer.

• Plans, organizes, and directs the professional medical services program, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.

• Designs and implements health plan medical policies, goals and objectives.

• Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Clinical Quality Management.

• Responsible for and assists with the development of budgets, staffing plans and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.

• Responsible and accountable for implementing the Utilization/Cost Management Program and Clinical Quality Improvement Program.

• Assists the Chief Medical Director with activities to promote positive community relations.

• Assures plan conformance with legal and regulatory requirements

• Assists the Chief Medical Director in creating and maintaining a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.

• Assists the Chief Medical Director in designing and implementing corrective action plans to address issues and improve plan and network managed care performance.

• Collaborates with Corporate Medical Affairs and the health plan Chief Medical Director in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.

 

Ms. Grimmett currently works for PricewaterhouseCoopers as an Assistant Director in their Revenue Advisory Services Department. She has served as an Allscripts Project Consultant, Athena contractor in their Coordinator Cores Department, a Revenue Cycle and Business Office Administrator Consultant with the Coker Group, an Office Manager at Atlanta Gastroenterology Associates and Practice Administrator for South DeKalb Pediatric Group as well as other medical facilities.  Previous experience also includes Financial Counselor and Lead Self-Pay Collector and Lead Patient Account Representative and Financial Counselor.

 

Ms. Grimmett is a Certified Professional Coder via AAPC Member (Atlanta Perimeter Georgia Chapter), Certified Financial Counselor  and Certified Patient Account Representative via Healthcare Financial Management Associates – Georgia Chapter.