I excel in fast paced environments and I have a strong understanding of the Revenue Cycle Management process for Physician/Facility medical claims. I work well with others, as well as independently. I am driven by results and have the ability to manage, coach, train and motivate others.
EOB Review/Contractual Adjustments
UB-04/HCFA 1500 claim forms
Physician and Facility Billing
Corporate Cash posting/Reconciliations
Govt/Non-Govt payer guidelines
Meeting deadlines and quotas
Patient Insurance and Benefit Eligibility
Education and Training
Bachelor of Science:Healthcare Administration2018National University, CA, US60 units remaining until completion.
Hospital Business Services Inc.Ontario, CARevenue Cycle Supervisor08/2016 to Current
*Oversee Billing and Collections team, 25 employees.
*Establishing department goals, and insure processes and procedures are adhered to.
*Monitor accounts receivables, and analyze denials and claims rejections as well as reimbursements in order to maximize collection.
*Document billing defects by establishing and conducting quality checks of billing transactions.
*Distribute daily ATB work lists to employees for A/R Collections
*Monitor daily productivity reports to ensure targeted goals are met
*Motivate, train, coach and provide clear guidance to team members to get the various billing tasks done properly and efficiently.
*Set performance goals and objectives for the billing teams, collection analysts, cash posters and EOB reviewers.
*Point of Contact for Hospital Admitting Managers, HIM, Coding and Appeal departments.
*Conduct weekly/monthly meetings to provide managerial reports and identify areas of improvements for the CBO teams.
*Hire, terminate assignments, coach, conduct annual performance evaluations, and provide disciplinary action for employees
*Identify payer denial trends
*Assign special projects, as needed.
Conifer Healthcare Solutions/Healthcare ScoutsAnaheim, CAPatient Account Representative07/2015 to 10/2015
*Follow-up on all claims from billing to final resolution.
*Review and prepare claim for manual and/or electronic submission.
*Identify billing errors for correction and resubmit claims to insurance.
*Follow-up on payment errors, low reimbursement, denials.
*Review payer contracts and insurance EOBs to initiate underpayment, timely filing, medical necessity appeals.
*Initiate, review and follow-up on claim appeal status
*Outbound calls to Provider and access payer portal websites to check claim status.
*Accurately and thoroughly documents the pertinent collection activity in account ledgers.
*Assist with cash posting, credit balances and adjustments.
*Communicate issues to management, including payer, system or escalated account issues.
*Adhere to productivity daily goals of 60 accounts
Trio Code KESLos Angeles, CAMedical Billing Lead06/2013 to 06/2015
Entry of all client insurance and financial information.
Prepare claim data for transmission to Medicaid, Medicare, and Managed Care Plans.
Review and process payment denials.
Organize billing and medical records for resubmission.
Assist with coding error resolution and distribute copies of coding errors to management for educational purposes.
Review, correct and log all claim errors and notify management of trends.
Follow up with insurance companies for status of claims and make adjustments according to polices.
Handle reverse charges, voids and transfer of payments.
Anthem Blue Cross of CaliforniaPomona, CACustomer Care Associate III11/2007 to 03/2012
Respond to customer questions via telephone, email, written correspondence regarding health insurance benefits,
provider contracts, eligibility and claims.
Analyze problems/concerns and provide information/solutions.
Thoroughly documents inquiry outcomes for accurate tracking and analysis.
Ensure customer request and questions are handled appropriately and in a timely manner.
Handle escalated calls/inquiries from customers, providers and account managers.
Initiate, track and provide status on provider/customer appeals.
Manually key Professional and Facility claims in to operating systems.
Effectively manage and distribute email inquiries to team members.
Direct contact for Account Managers and HR representatives.
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Companies Worked For:
Hospital Business Services Inc.
Conifer Healthcare Solutions/Healthcare Scouts
Trio Code KES
Anthem Blue Cross of California
Job Titles Held:
Revenue Cycle Supervisor
Patient Account Representative
Medical Billing Lead
Customer Care Associate III
Bachelor of Science : Healthcare Administration 2018
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