Detail-oriented Revenue Cycle Specialist with a systematic nature and good grasp of medical billing processes. Successful planner and problem-solver. Proficient in reducing debt, collecting payments and collaborating with insurance companies to resolve concerns. Talented communicator and practiced multitasker.
Skills
Medical Billing and Coding
Authorization procedure implementation
Insurance Verification
Contractual Compliance
Research and oversight
Skilled in ECW, Imagine, Centricity, Presidio Health, and Medisoft
20 + years experience with In and Out of network
Government and Commercial Payers Knowledge
Appeals
Claims review
Contributes to Team success and completion of goals.
HIPPA guidelines/regulations
Medical terminology, CPT, ICD-10 & HCPCS II
Out of Network TPA Repricing Negotiations
Able to read and Interpret Insurance Payer Contracts
Strong Analytical skills
Customer Service
Experience
04/2017 to 06/2021
Lead Revenue Cycle SpecialistNeighbors Emergency Center – City, STATE,
Coordinate the daily activities of team members and ensures all claims are worked or followed up on according to the productivity goals and objectives.
Collaborates with all departments to prioritize and implement improved processes to increase effectiveness on operations.
Delivered details on revenue cycles in layman's terms, enabling audiences to absorb information.
Participated in revenue cycle processes, working to maximize profitability and increase revenue.
Exercised proficiency in coding disciplines of outpatient, facility and physician care.
Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
Interacted with providers and other medical professionals regarding billing, coding, documentation policies and procedures regulations.
Minimized loss by negotiating out of network payment terms directly with clients, consistently achieving 90% recovery rate.
Contacted insurance providers to check patient coverage.
Remained calm, stayed professional and provided exceptional service on calls, even when interacting with difficult individuals.
Identified and corrected payment problems involving patients or third-party payers.
Presented regular status updates and workflow recommendations to senior management.
Assumes accountability for meeting expected outcomes through effective, efficient and ethical team operations.
04/2013 to 04/2017
Lead Collection SpecialistTexas Management Medical Services – City, STATE,
Coordinate the daily activities of team members and ensures all claims are worked or followed up on according to the productivity goals and objectives.
Collaborates with all departments to prioritize and implement improved processes to increase effectiveness on operations.
Delivered details on revenue cycles in layman's terms, enabling audiences to absorb information.
Participated in revenue cycle processes, working to maximize profitability and increase revenue.
Exercised proficiency in coding disciplines of outpatient, facility and physician care.
Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
Interacted with providers and other medical professionals regarding billing, coding, documentation policies and procedures regulations.
Minimized loss by negotiating out of network payment terms directly with clients, consistently achieving 90% recovery rate.
Contacted insurance providers to check patient coverage.
Remained calm, stayed professional and provided exceptional service on calls, even when interacting with difficult individuals.
Identified and corrected payment problems involving patients or third-party payers.
Presented regular status updates and workflow recommendations to senior management.
Assumes accountability for meeting expected outcomes through effective, efficient and ethical team operations.
04/2008 to 08/2012
Lead Collection SpecialistInstitute Of Cosmetic Surgery – City, STATE,
Out of network Reconstructive Surgery, Observation, radiology and physician billing.
Participated in revenue cycle processes, working to maximize profitability and increase revenue.
Accurately coded claims off the Operative Reports.
Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
Interacted with providers and other medical professionals regarding billing, coding, documentation policies and procedures regulations.
Minimized loss by negotiating out of network payment terms directly with clients, consistently achieving 90% recovery rate.
Contacted insurance providers to check patient coverage.
Remained calm, stayed professional and provided exceptional service on calls, even when interacting with difficult individuals.
Identified and corrected payment problems involving patients or third-party payers.
Presented regular status updates and workflow recommendations to senior management.
Assumes accountability for meeting expected outcomes through effective, efficient and ethical team operations.
Education and Training
Expected in to to
GED: San Jacinto Community College - Houston, TX, GPA:
Expected in 03/2001 to to
Certificate : Professional Medical Billing And Coding Professional Career Development Institute - Norcross, GA, GPA:
Accomplishments
Recognized as Employee of the Year in 2015 for outstanding performance and team contributions.
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