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Click here or scroll down to respond to this candidateCandidate's Name
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Cell PHONE NUMBER AVAILABLESummarySeeking a position within a well-established company that offers challenging opportunities, utilizes my skills, and provides an opportunity for advancement.Work ExperienceMEDICAL CITY ARLINGTON Arlington, TXJune 19, 2023 PresentHIM SpecialistProcessing medical record requests by in person patient request.Cover the duties of receptionist.General clerical duties include photocopying, fax, mailing, filing (electronic and paper), sorting and distributing correspondence.Upload Subpoenas to the online database for processing.Assists other employees as needed.Performs other duties as assigned by the Director.Processes requests for medical information from outside hospitals, clinics, and physiciansAssists Billers, and Coders through eRequest by obtaining documentation that is being requested for billing.Retrieving medical records and loose documentation from ancillary departments and nursing units, prepping, scanning, and indexing of the documents into HPF/MPF or E.H.RPerforming quality checks of documents scannedProcessing HIM incoming mail request and faxing to ROI.Processing physician suspensions, assist with the physician suspension process by evaluating if a physician should be put on suspension, creating the list of recommended suspensions for approval, sending out notice letters, making reminder calls, etc..IKON PAIN MANAGEMENT Midlothian, TXAugust 30, 2022 March 24, 2023Biller/Collector/Front OfficeSubmit claims to all payers through ATHENA.Prep and review denials for possible appeal/rebill.Review EOBs: Ensure claim paid per negotiated rate.Adjustments to accounts when needed.Follow up with payers on claim status and document appropriately, and Re-bill when needed.Check eligibility. Obtained authorization for procedures.Collect and Post Patient payments, along with setting up payment plan.Post Payer payments.Perform a wide variety of duties in support of the office, which include assisting patients with registration.Answer the phone, return patient phone messages and emails, and make confirmation calls in a professional and courteous manner.Candidate's Name Page 2Accurately schedule, change, and cancel appointments.Check patients in and out and schedule any needed appointments.Maintaining flow of patient check-in and check-out, verifying up-to-date demographics and insurance information within patients medical records.Rooming patients, taking vitals and detailed patient histories, documenting all patients.Record patient care documentation in the medical record accurately and in a timely manner.Prep charts to assure that all information required for patient visit is available for the provider.Clean and prepare exam rooms which include restocking medical supplies.Continuously communicate with the provider concerns cancellations, reschedules, no-shows, and specific needs of patients on the scheduleCollect and prepare laboratory specimens.Update electronic medical records.Medical Records scanningOpen and Close facility.Henry Mayo Newhall Urgent Care Valencia, CADecember 14, 2018 - November 8, 2019Biller/Collector (Remotely)Submit claims to all payers through ATHENA.Prep and review denials for possible appeal/rebill.Review EOBs: Ensure claim paid per negotiated rate.Adjustments to accounts when needed.Check eligibility and update accounts for re-bill.Follow up to payers on claim status and document appropriately.Post Payer payments.Correct patient accounts as needed, to include adjustments.Cedars-Sinai (affiliate Marina Del Rey Hospital) Los Angeles, CAWas transferred to Cedars-Sinai July 10, 2017 July 20, 2018Patient Financial ServicesPerform a wide variety of duties in support of the department, which include assisting patients.Accurately posts patient payments and credits to accounts.Take incoming calls related to patient statement/balance inquiries. Set up payment plans for patients and perform collection activities. Explain and provide financial policies and available resources for alternative payment arrangements to patients and their families.Handling of self-pay accounts for full payment, partial payment or long-term payment arrangements.Verify insurance eligibility benefits for services rendered with the payors and document appropriately.Handling customer inquiries regarding patient account receivable. Inquiries received via the mail, fax, telephone and/or in person. Research and resolve patient inquiriesReaching out to patients via telephone informing them of their outstanding balance and the reason for the balanceCandidate's Name Page 3Keeping track of necessary follow-ups/escalationsComplete PFS tasksProcess PFS e-mail tasksCorrect patient accounts as needed, to include adjustmentsMake outgoing soft collection calls as assignedReturn phone calls as a result of the voicemails left by patients or clinic staffTrain other staff members as requested.Marina Del Rey Hospital (Cedars-Sinai affiliate Hospital) Marina Del Rey, CAJanuary 2, 2009, to July 9, 2017 - Was Transferred to Cedars-SinaiBilling Coordinator/CollectorAssist Director of Revenue Cycle along with ER Manager with Special projects including day to day duties.Coordinate billing work list for billers to insure maximum production.Identify and correct account information when applicable; update patient demographic information in Siemens in order for ePremis to be in sync.Submit claims to all payers through ePremis upon receipt of daily claims submissions from hospitals patient accounting system.Review accounts daily to insure all accounts are being billed correctly and in a timely manner.Monitor daily to insure that all accepted claims are being released during the scheduled time assigned and that the system is functioning properly. Coordinate with ePremis, hospitals electronic billing system vender to resolve system issues that may occur.Generate daily hold reports to make sure requested claim information is accurate and received in a timely manner. (Medical records, coding issued, claims corrections).Write payers edits to improve validation rate to 90% evidenced by daily claims submission report.Work cohesively with providers, insurance carrier, and facility case managementPrep and review denials for possible appeal.Prep and review denials for Retro Review, Obtained Medical Records.Work all Credit Accounts- audit adjustments, & review payments.Review EOBs: Ensure claim paid per negotiated rate.Review and Process daily Billing for all Commercial, Managed Care and Government Managed Care claims.Mail all paper claims to payers and any documents as needed.Review all In-Patient and Out-Patient HMO accounts that an authorization was obtained for service. Following up with financial counselors daily with those accounts not approved before releasing claim.Daily QA on registrationWork closely with case management for those accounts that have a denial for non- medical necessity and obtain a letter of medical necessity for Patient stay /procedure for a payable bill. Also sending out a weekly report to them for all claims that have been denied. Obtain a LOMN for these accounts to be re-processed.Send out a daily follow-up report to the front-end registration department to obtain health and work comp insurance information for those accounts that are pending insurance information from patients.Assist staff with any problem accounts.Perform other duties as assigned.Candidate's Name Page 4Kaiser Permanente Pasadena, CAJanuary 3, 2007, to December 31, 2008Contractor with HRG - Project ManagerAssist Assistant Director of Revenue and Banking Services along with Regional Supervisor of North Operations, Regional Supervisor of South Operations and Supervisor of Research Unit with Special projects including day to day duties.Maintain 34 Payment Posters productivity from both divisions in a report that is given to the Assistant Director.Maintain attendance calendar for 40 employees for each Regional Supervisor.Daily QA review on Posting Batches for 34 payment posters.Due corrections on Posting Batches and keep log on Posters errors.Review errors with the Posters and assist them when needed in making their corrections.Contact Payors to have them add any missing information such an account numbers or service descriptions on the EORs that is required for posting. Im continuously following up with Payors until the issue is resolved and we have a corrected EOR for entry and closing of the batchAssist Reimbursement Analyst with their data entry - when they are out of the office, or their work is backed up.Quarterly do a Payment Posting Audit on all the Posters for North and South OperationsPrepare/Maintain Quarterly SOX review report on 34 payment postersAssist Auditors throughout the year with on task that is needed on Quarterly SOX reviewBROTMAN MEDICAL CENTER / Culver City, CAPEROT SYSTEMS HEALTHCARESeptember 1, 2005, to January 2, 2007Terms & Conditions Supervisor / Hospital Collector Supervisor for HMO / PPO /Managed Care/Customer Service SupervisorWork directly with CFO, Assistant CFO, Director and Manager of Business Office with Special projectsMaintain and perform month end analysis of contractual allowance for month end reporting.Work closely with CFO & Assistant CFO after month end reviewAssist BOM with special projects and assist in contacting payers to assist with payment of pending claims.Contract managementReview all new managed care contracts terms and conditions.Obtain, review and negotiate new/old contracts and complete new applications.Maintained existing contracts and files for HospitalNotify Business Office Director of any pending contact expirations.Continuously update databases with contract changes due to conversionContact person for all Managed Care IssuesReview case rate on a regular basis for Medical Groups and Health PlansResponsible for distribution of all contract information to required departments/facilities.Work on daily adjustments to have clean accounts for month endNet patient accounts down to correct insurance reimbursementProvide training to appropriate staff to read and interpret contracts.Candidate's Name Page 5Distribution of assignments to staff members as well as reviewing completion of their work.Solving customer services and insurance issuesCheck eligibility, verification, Obtain authorizations/referrals for servicesReview, analyze and collect on outstanding receivables on patient accountsas assigned per client specificationsAssists patients and insurance companies in resolving problem account balances and perform collection follow-up on accounts.Preparing denied claims for rebillingTrack progress on resolutions for patient accountsReview and assist patients and insurance companies in their overpayment refunds requestAbsolute Control Services, Inc. Los Angeles, CAContractor at Orthopedic HospitalJune 10, 2002 - August 31, 2005Payor Contracting Specialist / HMO CoordinatorHospital Collector for HMO / PPO / Managed Care / Medi-Cal for In & Out PatientsMaintained existing contracts and files for Hospital and PhysiciansMaintained positive relationships with Health Plans to insure maximum reimbursement.Continuously update databases and Payors based upon changes made in Hospital.Assist Director of Patient Accounts with Special projectsCollection on all HMO/PPO/Managed Care/Medi-Cal accountsCollection on Private Pay accountsPreparing for denied claims for rebilling.Track progress on resolutions for patient accountsCheck eligibility and verification.Obtain authorizations/referrals for services.MD Services / Health Check Information Center Westlake Village, CA(Contract Basis) July 1, 2002 - August 15, 2003Network Administrator / Payor Contracting SpecialistObtain, review and negotiate new contracts and complete applications for imaging centers.Continuously update databases and Payors based upon changes made in Radiologist, in center address, change in ownership (change in TIN), in lockbox, change of legal or DBA name, change in terms of contract, new modalities.Acquired data for opening of new imaging center business.Research articles and information for website, Assisted in designing website for new networkDesign market materials, Market clients for networkSchedule appointments for network, Insurance verification for imaging centersPreparing reports for each imaging center - (Patient and Physician count for each month)Candidate's Name Page 6Comprehensive Medical Imaging / SYNCOR Woodland Hills, CAJune 19, 2000- June 7, 2002 - Payor Contracting AssociateObtain, review and negotiate new / old contracts and complete new applications for over 64 imaging centers (multi-modalities)Maintained existing contracts and files.Acquired data for opening of new imaging center business.Responsible for distribution of all contract information to required departments/facilities.Continuously update databases and Payors based upon changes made in Radiologist, in center address, change in ownership (change in TIN), in lockbox, change of legal or DBA name, change in terms of contract, new modalities.Assist Manager with Special projects.Distribution of assignments to staff members as well as reviewing completion of their work.In charge of all National and Regional contracts along with individual center contracts.Valley Presbyterian MR Center (US Diagnostic, Inc.) Van Nuys, CAMarch 7, 1994 June 16, 2000Front Office Registration / Administrative Assistant / Office ManagerAssistant to Center Manager and Marketing Representative in day-to-day duties.Contract Management Manager, Film Library Department and PayrollMaintained existing contracts and fillies.Insurance verification for 3 Out-Patient Imaging Centers.Solving customer service and insurance issues.Coordination of daily schedules for 3 Out-Patient Imaging Centers (2 MRI only and 1Multi-modality).Patient registration, Patient scheduling, Data EntryDistribution of assignments to staff members as well as reviewing completion of their work.Other duties as required.Universal Medi-Co Monterey Park, CAAugust 17, 1987- November 27, 1992Front Office / Insurance Verification / Coordinator / SupervisorPatient Registration including Chart preparation.Patient Scheduling, Answer phones, Insurance verification, and Obtained Authorization.Collect and Post Patient payments, along with setting up payment plan.File / Copy Records, Data EntrySend out a daily follow-up report to the front-end registration department to obtain health and work comp insurance information for those accounts that are pending insurance information from patients.Assist staff with any problem accounts |
