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Click here or scroll down to respond to this candidateCandidate's Name
Street Address GREY PARK DRSAN ANTONIO, TEXAS Street Address
Cell: PHONE NUMBER AVAILABLEEMAIL AVAILABLESKILLS Professional Certified Medical Claims and Billing Specialist Strong knowledge of administrative and clerical processes Highly skilled in multi-tasking Exceptional customer service practices Bilingual (English/Spanish) Trained and knowledgeable of expansive electronic medical records (EMR), ICD-10 and CPT codes, medical claims and Billing Software (Advanced MDI, MDI, Artiva, Centricity, E- Clinical, IMS Availity, Nov-Net, TriZetto, Lytic, Moms Systems, Athena, NextGen, Microsoft Office programs, True care, and Ika- Claims. Updox, Aprima, Community 1st Medicaid, Tricare Humana Military, UHC CignaWORK EXPERIENCEBiologics Insurance Verification/ Prior Authorization Allergy SA Asthma Immunology Associates of South Texas October 2023 - July 2024 Verifies insurance coverage for new patients, referrals and prior authorizations Updates information for existing patients, and provides information to patients before medical services Confirms patients insurance is active, to ensure healthcare services are covered Researches eligibility information online with various insurance carriers Provides patients with information about their benefits to help them understand their financial responsibilities Responsible for incoming and outgoing calls to patients to confirm insurance verification prior to their medical appointments Displays exceptional communication to all patients, physicians, medical billers, while providing great customer-service and problem-solving skillsReferral CoordinatorChristus Santa Rosa Hospital Westover Hills June 2021 - March 2023 Reviewed incoming faxes from providers authorizations per the members provider requests Worked with hospitals, office visits, referrals, PCP, Surgeries facilities and the clinical team to manage requests for services from members and providers. Insurance verification and referrals. Coordinating the entire referral process obtaining order from physician, obtaining insurance Company payor, scheduling the appointment for the patient with a physician who accept the Particular insurance, notifying the patient of the appointment, completing renewal Authorization with physicians office and payor Researches problems referral claims or requests for payment and corrects Utilized and Understand CPT- Codes and ICD-9 Coding to process proper referral Contracted UM CoordinatorUnited Health Group February 2020 - March 2021 Reviewed incoming faxes from providers and build hospital intake or observation authorizations per the members provider requests. Prepared invoices using medical codes and resolved billing inquiries. Processed referrals, and build prior authorizations for providers, including intake, notification and census roles. Worked with hospitals, office visits, Referrals, PCP, Surgeries facilities and the clinical team to manage requests for services from members and providers. Responsible for verifying patient-eligibility, coordinating benefits, and facilitating insurance coverage. Skills in gathering, analyzing and evaluating patient information. Reviewed daily faxes intakes for IP- inpatient Hint OBS, Admin, discharge and PA-OP- outpatient, Retro referrals for services that were rendered either office visits or outpatient surgical procedures. Utilized and understood ICD-10 and CPT codes.Medical Records/Billing SpecialistSouth Texas Radiology Imaging Center (STRIC) March 2019 - January 2020 Gathered patient information by collecting demographic information from a variety of sources. Performed processing functions necessary to ensure timely and accurate insurance billing. Retrieved corporate documents, records, and reports from various doctors offices and hospitals. Filled incoming correspondence, including faxes, and emails with patient information. Communicated with customers effectively to provide adequate customer service. Provided Medical Records to support other departments. Created work orders, burn CDs, and scan documents. Efficient with using Windows Risk AGFA and Meditec Short Keys programs. Customer Service RepresentativeCity of San Antonio January 2018 - February 2019 Approved, scheduled, and scanned engineering documents Assisted customers in obtaining permits Filled paperwork and incoming mail Scheduled appointments and meetings for inspectors Communicated with customers Distributed tickets and applications to customers Listened to audit to schedule inspectorsProvider Utilization Coordinator / Billing Coordinator QTC Medical Group November 2016 - December 2017 Supported VAO operations Prepared and reviewed medical bills and resolved billing inquiries Effectively utilized reports and tools to communicate IPA schedules to providers Responsible for building and adjusting providers schedules Prioritized operations and providers requests when necessary Proactively communicate issues/concerns with leadership teams Efficiently utilizes electronic tools and workflows in order to manage resources Medical Office Specialist / Billing ClerkMethodist Cardiology Clinic of San Antonio March 2016 - September 2016 Scheduled hospital surgeries and testing In charge of patient registration, patient check in and patient check out and In-bound Prepared and reviewed medical bills and resolved billing inquiries Answered phones and sent fax requests to doctors and hospitals Pre-Authorization Prepared patient charts for filing Handled medical record request Insurance verification and referrals EMR-NEXTGENUnderpayment AnalystParallon/HCA January 2015 - December 2015 Generated letters to individual medical insurances regarding underpayments or denials that required appeal Prepared medical invoices and review medical claims Ensured prompt and effective follow-up to recover accurate payments Analyzed patient hospital claims in regard to expected reimbursement based on managed care contract terms and regulation and accurately following up on appeals to ensure timely collections on underpaid or denied claimsAdministrative Assistant C.E.O.C.J. Machine Inc. April 2012 - July 2014 Greeted Customers, Patrons, or Visitors, Answer telephones to direct calls or provide information Performed general office duties, such as ordering supplies, maintaining records management database systems Ordered materials, supplies, or equipment Filled and retrieved corporate documents records, and reports Opens, sorted, and distributed incoming correspondence, including faxes and email Provided Administrative support to other departments Medical Records / Billing SpecialistHeart & Vascular Institute of Texas October 2009 - June 2011 Handled medical record request Medical Claims and billing In charged of patient registrations and patient check out Collected Co-Payments Prepared patient charts and filing Insurance verification and referrals EMR/Athena NetFront Office Receptionist / Billing ClerkCarrasco Pain Institute September 2008 - October 2009 Workmens Compensation billing Insurance verification and referrals Scheduled and confirmed patient appointments In charged of patient registration and patient check-out Medical Claims and billingCustomer Service RepresentativeUSAA Federal Saving Bank March 2007 - February 2008 Assisted members with inquires and transactions Provided Customer support for the call center Assisted with research, analysis and resolved member account concerns Contacted members that had delinquent accountsEDUCATIONHigh School Diploma - Received 1985McCollum High School, San Antonio, TexasCERTIFICATION AND LICENSESProfessional Medical Claims & Billing Program - Certification Received 2004 |
