Gabrielle Frails
Augusta
Summary
Dedicated Billing and Claims Specialist recognized for analytical skills and attention to detail. Proven track record in resolving complex claims issues and enhancing department satisfaction through effective communication and teamwork.
Overview
24
24
years of professional experience
Work History
Billing and Claims Specialist
Wellstar MCG Health (Formally AU Health) 17 years
Augusta
10.2024 - Current
- Reviewed and processed insurance claims, ensuring accuracy and completeness to facilitate timely payments.
- Communicated with healthcare providers to clarify claim details and requirements.
- Utilized claims management software to track and manage claim statuses.
- Investigated discrepancies in claims, conducting thorough research and analysis to resolve issues effectively.
- Collaborated with team members to resolve complex claim issues efficiently.
- Documented claim resolutions and maintained detailed records in the system.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Analyzed insurance claims to confirm validity, completeness, and accuracy, ensuring eligibility for payment.
Claims Processing Rep.
Augusta University Medical Associates (AU Health)
Augusta
11.2010 - 10.2024
- Processed insurance claims for diverse patient services at AU Health, ensuring timely reimbursement.
- Reviewed claim submissions for accuracy and compliance with policies, reducing potential rejections.
- Collaborated with healthcare providers to resolve discrepancies in claims documentation, facilitating smoother processing.
- Utilized electronic health record systems to track and manage claims status effectively.
- Assisted in training new staff on claims processing protocols and systems usage.
- Verified eligibility, benefits, authorization requirements for services rendered.
- Applied knowledge of insurance plans, regulations and guidelines in adjudicating claims.
- Maintained accurate records of all claim processing activities in a timely manner.
Mailroom/Imaging Clerk
Augusta University Medical Associates (AU Health)
Augusta
07.2009 - 11.2010
- Processed medical imaging requests for various departments, ensuring timely access to critical patient information.
- Assisted staff in retrieving and organizing imaging files and documents, enhancing workflow and data accessibility.
- Operated imaging systems and ensured proper functionality daily.
- Ensured compliance with privacy standards in handling patient data.
- Ensured that all necessary documentation was completed accurately and submitted on time.
- Performed clerical duties including filing, scanning documents, and entering data into computer system, maintaining accurate and up-to-date medical records.
- Completed transmittal logs and stored them for future reference.
- Developed electronic, CD and hardcopy data books.
Crew Member
McDonald's
Martinez
03.2009 - 07.2009
- Delivered exceptional customer service in fast-paced dining environment.
- Operated cash register, ensuring accurate and efficient customer transactions.
- Maintained cleanliness of dining area and kitchen equipment.
- Collaborated with team to streamline operations during peak hours, enhancing service flow.
- Trained new crew members on service protocols and procedures.
- Restocked supplies to support inventory management and ensure availability for customer needs.
- Performed cashier duties such as taking orders, collecting payments and providing change.
- Served food quickly for positive guest experiences.
Sales Support/Recovery Team (Seasonal)
JCPenney
Augusta
12.2008 - 01.2009
- Executed day-to-day duties with accuracy and efficiency, ensuring smooth operations.
- Prioritized and organized tasks to meet service goals effectively and enhance customer satisfaction.
- Identified needs of customers promptly and efficiently.
- · Stocked newly arriving merchandise daily
- · Floor recovery, and merchandise pricing
- Assisted Recovery Team in organizing and restocking merchandise to maintain store presentation.
Cashier/Customer Service/Returns
Lowes Home Improvment
Augusta
01.2007 - 10.2008
- Processed customer transactions using point-of-sale systems, ensuring accuracy and speed to enhance checkout experience.
- Assisted customers with product inquiries and locating items in the store.
- Maintained accurate cash drawer balance throughout shifts consistently.
- Handled returns and exchanges according to company policies, maintaining customer satisfaction and compliance.
- Provided exceptional customer service, contributing to a positive shopping experience and fostering customer loyalty.
- Resolved customer complaints promptly and professionally.
- Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
- Greeted customers and answered any questions they had about the store's products and services.
- Stocked shelves with merchandise when needed.
Store Sales Associate
Bath & Body Works (Augusta Mall)
Augusta
08.2006 - 10.2006
- Guided customers in selecting and purchasing products, ensuring satisfaction and repeat business.
- Executed accurate transactions at point of sale, contributing to operational efficiency and customer trust.
- Stocked shelves and organized product displays effectively.
- Delivered product knowledge and tailored recommendations to enhance customer experience and drive sales.
- Participated in promotional events and sales initiatives actively.
- Processed cash and credit card payments accurately and efficiently.
- Supported team members with daily tasks such as cleaning, pricing or organizing merchandise displays.
Outpatient Pharmacy Volunteer
American Red Cross - Eisenhower Army Medical Cen.
Fort Gordon
05.2002 - 07.2002
- Supported pharmacy staff in preparing and organizing medications, enhancing patient care delivery.
- Provided patients with information about prescriptions and services, fostering informed healthcare decisions.
- Managed inventory of pharmaceutical supplies and equipment, ensuring operational readiness.
- Ensured compliance with safety standards and regulations in pharmacy operations.
- Prepared and organized medication orders for patients.
- Stocked pharmacy shelves efficiently to ensure product availability.
Education
Medical Coding And Billing - CPC
2025 Medical Coding Training Class
Augusta, GA12-2025
High School Diploma -
Harlem High School
Harlem, GA05-2006
Some College (No Degree) - Psychology
Augusta University
Augusta, GASkills
- Claims processing
- Medical billing
- Claims investigation
- Data entry
- Microsoft office
- Problem-solving aptitude
- Multitasking
- Attention to detail
- Effective communication
- Team collaboration
Timeline
Billing and Claims Specialist
Wellstar MCG Health (Formally AU Health) 17 years
10.2024 - Current
Claims Processing Rep.
Augusta University Medical Associates (AU Health)
11.2010 - 10.2024
Mailroom/Imaging Clerk
Augusta University Medical Associates (AU Health)
07.2009 - 11.2010
Crew Member
McDonald's
03.2009 - 07.2009
Sales Support/Recovery Team (Seasonal)
JCPenney
12.2008 - 01.2009
Cashier/Customer Service/Returns
Lowes Home Improvment
01.2007 - 10.2008
Store Sales Associate
Bath & Body Works (Augusta Mall)
08.2006 - 10.2006
Outpatient Pharmacy Volunteer
American Red Cross - Eisenhower Army Medical Cen.
05.2002 - 07.2002
Medical Coding And Billing - CPC
2025 Medical Coding Training Class
High School Diploma -
Harlem High School
Some College (No Degree) - Psychology
Augusta University