Traci Groholske CPC, CRC, CH-CBS
Elkhart
Summary
Dedicated Lead Claim Specialist with expertise in billing accuracy and denial resolution. Successfully lead provider education initiatives, significantly improving documentation compliance and clean claim submission rates.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Lead Claim Specialist
Grace Health
Battle Creek, MI
01.2025 - Current
- Lead provider coding education and billing training initiatives, strengthening documentation accuracy and CPT/ICD-10 compliance.
- Reviewed diagnosis and procedure submissions and corrected discrepancies, improving clean claim rates.
- Monitored unbilled and held encounters while collaborating with revenue cycle leadership, reducing charge lag and workflow bottlenecks.
Claim Specialist II
Grace Health
Battle Creek, MI
09.2019 - 01.2025
- Validated CPT and ICD-10 codes after reviewing provider documentation, facilitating accurate claim generation.
- Resolved billing and payer edits across Medicare, Medicaid, and commercial plans, accelerating reimbursement turnaround.
- Communicated directly with providers regarding clarifications and missing documentation, strengthening compliance and audit readiness.
- Promoted to Lead Claim Specialist
Billing and Recovery Specialist
Quality In Real Time
Battle Creek, MI
06.2018 - 09.2019
- Managed billing and accounts receivable for multiple home health care practices, improving claim resolution timelines.
- Analyzed denial trends, working to capture maximum payment through claim resolution and appeals processes, increasing revenue recovery.
- Navigated multiple EHR platforms to reconcile accounts and billing errors, supporting operational efficiency.
Lead Biller
ProMedica Hospital (currently Insight Hospital)
Coldwater, MI
04.2017 - 06.2018
- Directed Medicare and Medicaid billing for hospital accounts, facilitating compliant reimbursement practices.
- Performed payment reconciliation and maintained A/R reporting to senior staff members.
- Investigated claim variances and resolved payer issues, minimizing write-offs.
Patient Care and Technical Support Specialist
Hearing Life
Battle Creek And Sturgis, MI
02.2013 - 03.2017
- Obtained medical clearances for payer directives to ensure coverage of services and hearing devices also submitting all necessary documentation and claims to payers.
- Managed scheduling of all testing, technical support, and device maintenance appointments.
- Provided technical support for hearing devices, troubleshooting issues effectively.
- Assisted customers with device setup and usage, ensuring satisfaction.
- Documented customer interactions and resolutions in CRM systems accurately.
- Trained new staff on technical support processes and software tools.
Medical Billing Coordinator/Surgery Scheduler
Pradhan Center for Women
Coldwater, MI
04.2010 - 02.2013
- Assigned ICD-9 and CPT codes and submitted electronic claims, improving billing accuracy and payment flow.
- Posting of all payer and patient payments to claim and patient balances and maintenance of all reports related to A/R.
- Coordinated insurance authorizations and surgical scheduling, ensuring patient access to care.
- Transitioned practice from paper charts to EMR and clearinghouse submission platform, enhancing revenue cycle integrity.
Education
Bachelor of Science - Business Administration
Siena Heights University
Adrian, MI12-2013
Certificate - Medical Billing And Coding
Marion Technical College
Marion, OH06-2006
Skills
- CPT, ICD-10, Risk Adjustment (HCC), and HCPCS Coding
- Chart Review for Code Validation and Proper Documentation
- Claim Submission (Medicare, Medicaid, Commercial)
- Claim Edit and Denial Resolution
- FQHC Billing
- Provider Coding and Documentation Education
- Billing Staff Training and On-Going Education
- Insurance Verification
- Practice Management Systems / EMR Navigation
- Microsoft Office Suite
- HIPAA Compliance
Certification
AAPC
- Certified Professional Coder (CPC) 2020
- Certified Risk Adjustment Coder (CRC) 2023
ArchPro Coding
- Certified Community Health Coding & Billing Specialist 2021
Timeline
Lead Claim Specialist
Grace Health
01.2025 - Current
Claim Specialist II
Grace Health
09.2019 - 01.2025
Billing and Recovery Specialist
Quality In Real Time
06.2018 - 09.2019
Lead Biller
ProMedica Hospital (currently Insight Hospital)
04.2017 - 06.2018
Patient Care and Technical Support Specialist
Hearing Life
02.2013 - 03.2017
Medical Billing Coordinator/Surgery Scheduler
Pradhan Center for Women
04.2010 - 02.2013
Bachelor of Science - Business Administration
Siena Heights University
Certificate - Medical Billing And Coding
Marion Technical College