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Professional Summary
To work in a progressive organization where my background in management support and abilities can be utilized for the fullest extent for future growth.
Skills
  • Microsoft Word
  • EPIC Software
  • Ouadax
  • Power Path
  • File Maker Pro
  • Microsoft Windows
  • Excel
  • Medical Manager Software/Program
  • Novartis Database
  • SoftMed Software/Program
  • Punctual
  • Medical Billing/Claims
  • Assist Medical Assistance
  • Filing/Editing
  • Typing (45-50 wpm)
  • Office Procedures
  • Telephone Skills
  • Data Entry
  • Xerox
  • Facsimile machine
  • Fast Learner
  • Patient Care Coordination
  • Case Manager
  • Assist management with Special Projects
  • Quality Assurance/Analyst
  • Train new hires as a Reimbursement Counselor
  • Word Processing
  • 10 key
  • Ability to work under minimal supervision
  • Customer-oriented
Work History
Patient Account Representative II, 05/2015 to Current
Stanford Healthcare Palo Alto, CA
Collect and follow up on all accounts assigned prior to, during, or after admission and discharge. Communicated financial policies to all patients.Verified, researched, and completed all paperwork to billed Medicare and Medicaid claims for reimbursement.Served as patient advocate during the entire cycle of the account through telephone, mail, and research efforts. Medicare Collector/Billing.Working reports for Credit balances, refunds, bad debt, and IME billing. Re-billed Inpatient/Outpatient claims, updated insurance information.Work (RTP) Return to provider claims and issues using resources and DDE/FSS Medicare/Medicaid GAMMIS system. Contact commercial and government payers regarding underpaid and denied claims as well as contacting patients regarding claim issues.Handle correspondence from insurance companies regarding billing questions, billing issues, and medical claim denials. Identify and correct any coordination of benefit problems identified on patient accounts. Process refund requests for insurance overpayments and patient overpayments and confirm claim underpayments/overpayments by analyzing the insurance explanation of payments and insurance contracts.Identify authorization, cash posting, and registration errors on patient accounts and route to the appropriate department for correction. Submit unfilled or corrected UB04 and CMS 1500 claims by utilizing Quadax/Xpeditor software. Performed and facilitated claims processing with third party payers for coordination of benefits. Managed claim denials by contacting clinical department, patient, payor or fiscal intermediary by phone, email or appropriate websiteInitiated appeals on denied hospital claims requiring detailed research for claim resolutionCommunicated to and advised appropriate staff of changing payor policies, denial trends and policiesMaintained patient accounting files requiring detailed notes, manual logs and on-line functions for submission to third party payers assisted with claim edits.
Reimbursement Counselor/Case Manager, 09/2009 to 05/2015
Lash Group San Bruno, CA
Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payers. Builds relationships with patients, caregivers, HCSs, and Sales Team to collect / share information and coordinate participation in the program. Communicates with insurance companies, and third-party vendors to collect / share information and coordinate participation in the program. Researches available disease-specific information in the assigned region: events, activities, resources, support groups, etc. Handles complex calls in a call-center environment. Communicates with internal and external departments to facilitate coordination of information / resources. Reports Adverse Events (AE) and Product Quality Complaints (PQC), as required and as per policy. Strictly adheres to Standard Operating Procedures (SOPs). Accurately interprets patient insurance, prescription and other health-related documentation, as needed. Validates and enters prescription orders, as appropriate. Completes casework in a timely manner with consistent follow-up as the accountable case manager. Maintains patient confidentiality. Advocates on behalf of the patient to problem-solve any issues or obtain necessary information. Understands prescription drug benefit management techniques including Formularies, Prior Authorizations, etc. Performs clerical and administrative functions such as mailing and faxing correspondence, data entry, scheduling, etc. Acquire/Exhibit/Maintain subject matter expertise in the area of the liver disease, including but not limited to the condition, treatment, community of patients and caregivers, activities and events offered throughout the country, etc., to ensure staff is providing the appropriate support / service(s).
Medical Assistant/Medical Billing, 09/2006 to 09/2009
Gastroenterology Consultants of the Peninsula Burlingame, CA
Collects delinquent accounts by establishing payment arrangements with patients; monitoring payments; following up with patients when payment lapses occur. Utilizes collection agencies and small claims court to collect accounts by evaluating and selecting collection agencies; determining appropriateness of pursuing legal remedies; testifying for the hospital in court cases. Maintains medicare bad-debt cost report by tracking billings; monitoring collections; compiling information. Initiates claims against estates by monitoring deaths and unpaid accounts; informing legal department to act on probate and estate issues; following-up with clerk of court. Secures outstanding balance payments for care of hospital employees by establishing payroll deductions; obtaining signatures for automatic transfers. Secures obstetrical payments by interviewing and obtaining information from pre-delivery patients; establishing payments due prior to delivery; sending monthly statements. Maintains work operations by following policies and procedures; reporting compliance issues. Maintains quality results by following standards. Protects hospital's value by keeping collection information confidential. Updates job knowledge by participating in educational opportunities. Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements and standards. Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments. Report to clinical coordinator or practice administrator. Perform nursing procedures under supervision of physician or physician assistant. Assist physician and physician assistant in exam rooms. Escort patients to exam rooms, interviews patients, measure vital signs, including weight, blood pressure, pulse, temperature, and document all information in patient's chart. Give instructions to patients as instructed by physician or physician assistant. Ensure all related reports, labs and information is filed is available in patients' medical records prior to their appointment. Keep exam rooms stocked with adequate medical supplies, maintain instruments, prepare sterilization as required. Take telephone messages and provide feedback and answers to patient/physician/pharmacy calls. Triage and process messages from patients and front office staff to physicians and physician assistants. Maintain all logs and required checks (i.e. refrigerator temperatures, emergency medications, expired medications, oxygen, cold sterilization fluid change, etc.). All other duties as assigned by clinical coordinator or practice administrator.
Intake Coordinator, 04/2005 to 08/2005
Adecco Temp. Agency/Genentech Inc. South San Francisco
Receives and coordinates all referrals to include notification of insurance providers for prior authorization and services covered. Responsible for the review of daily logs and notes from Case Managers to assure continuity of care, documentation of nursing process, appropriateness of intervention/action and timeliness of documentation. Using discretion and independent judgment in handling patent or physician complaints received documents and forwards to appropriate administrative staff. Responsible for maintaining supply inventory as well as daily distribution of supplies to field staff. Maintains log and any reports essential for appropriate billing and reorder process. Communicates with Branch Manager any information received from physician, patent or employees about the patents care or needs. Primary contact for receiving phone calls to the branch office. Takes physician orders by phone, documents, notifies appropriate Case Manager and adjusts schedules accordingly as indicated. Files all office records as necessary. Provide direct patient care on an as-needed basis, as assigned by Branch Manager. 
Patient Registrar, 11/2003 to 04/2004
Seton Medical Center Daly City, CA
Registration specialists help assign beds and carry out procedures to admit, transfer, or discharge patients. Input patient information into a computer system and verify necessary physician referrals and insurance authorizations. All tasks must be performed with close adherence to both hospital rules and regulatory compliance. Help ensure clients properly fill out and sign all relevant insurance and hospital release forms. Explain financial options to patients. Collection and processing of payments. Maintain accurate record of payments received and provide patients' insurance companies with the proper paperwork that reflects all related transactions. Maintain and balance a cash drawer as well.
Medical Records, 08/2000 to 10/2001
UC San Francisco Hospital San Francisco, California
Gathers patient information by collecting demographic information from a variety of sources; interacting with registration areas and physicians' offices; retrieving information from automated printer. Maintains master patient index by completing assigned portion of daily audit trail; corrects and communicates problems according to established procedures. Initiates the medical record by creating and processing the patient care record folder. Maintains record availability by processing charts into the department; using chart mark-off procedures; facilitating chart location activities. Retrieves medical records by following chart-out procedures; documenting reasons charts cannot be retrieved for statistical and follow-up purposes. Delivers charts to assigned areas of the hospital by following established routing procedures. Keeps health care providers informed by communicating availability or unavailability of the record. Maintains quality results by following hospital standards. Maintains continuity of work operations by documenting and communicating actions, irregularities, and continuing needs. Maintains patient confidence by keeping patient records information confidential. Enhances medical records and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.  
Education
High School Diploma: Westmoor High School - Daly City, CA
Bachelor of Arts: Trident Technical College - Charleston, SC
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Professional Summary

Enthusiastic Customer Service Associate bringing diverse experience in retail sales and customer service.  Self starter with substantial communication skills.  Known as a dependable and professional employee. Proficient in cash register operations and inventory maintenance. An excellent team player with the initiative to provide the highest quality of customer service. 

Skills
  • Microsoft Office
  • Conflict Resolution
  • Leadership and Management
  • Excellent people skills
  • Customer service focus
  • Exceptional customer service
  • Adapt to diverse groups
Work History
Temporary Patient Account Representative 07/2018 to 09/2018
Montefiore Mt Vernon/ New Rochelle via Winston Staffing Bronx, NY
  • Confirmed patient Medicaid eligibility.
  • Cross referenced visit and registration intake from Allscripts before submission of claims. 
  • Electronically submitted bills according to compliance guidelines.
  • Followed up on claims submitted to ensure receipt of payment for services rendered. 
Behavioral Health Associate 01/2016 to 04/2018
Fidelis Care of New York- Regional Office Rego Park, NY
  • Created pre-certifications, prior authorizations, and post service request.
  • Confirmed billable and non-billable CPT codes.
  • Referred cases requiring clinical review to case managers.
  • Authorized initial set of outpatient sessions for providers.
  • Provided eligibility status and benefit information specific to each plan. Conducted a thorough radius search for in-network providers for members per request.
  • Followed up with members during and after care.
Temporary Member Service Associate 11/2015 to 01/2016
Fidelis Care of New York- Regional Office via Winston Rego Park, NY
  • First point of contact between Fidelis Care, members and providers.
  • Responded to inquiries via telephone and written correspondence regarding benefit, eligibility, premiums and claims.
  • Analyzed problems, educated and provided solutions.
  • Documented information, activites and changes to database to ensure it reflected the activity performed on member accounts. 
  • Managed HIPAA Privacy Release Form project designed to ensure and uphold the privacy of member accounts. 
Sales Associate 10/2012 to 02/2013
Gap Inc Manhattan, NY
  • Developed positive customer relationships through friendly greetings and excellent service.
  • Answered questions regarding the store and its merchandise.
  • Organized racks and shelves to maintain the visual appeal of the store.
  • Monitored entrances, exits and fitting rooms for signs of theft.
  • Worked collaboratively in team environment.
  • Directed individuals to merchandise locations.
Billing Support Coordinator 03/2010 to 01/2014
Health and Home Care Elmhurst , NY
  • Managed RN's, reviewed patient assessment forms for accuracy and completion by RN's.
  • Created detailed reports summarizing data collected by RN's.
  • Cross referenced time sheets and patient assessment forms for payroll accuracy.
  • Collected specimens from patients residence for laboratory testing.
Education
Pending- Associates of Applied Science : Health and Human Services 2019 Mandl School, The College of Allied Health - New York, NY
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Summary
Driven Insurance Representative trained in all aspects of insurance billing, claims and collections. Employs high-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem solver. Knowledge of hospital systems such as Meditech, Epic and Medassets.
Skills
Professional and friendly, Multitasking and organizing, Knowledge of HIPAA, Customer service, Bilingual 
Experience
Insurance Representative
November 2015 to Current
BCA Financial Services Inc Miami, FL
  • Responsible for reviewing patients' case and insurance coverage information to personalize the call contents to the patient.
  • Ensure timely processing of benefit information and seek assistance from management when necessary.
  • Acquire billing information by verifying Worker's Compensation accounts and MVA.
  • Verifying HMO,PPO, and Commercial plans.
Patient Account Representative
March 2013 to November 2015
BCA Financial Services Inc Miami, FL

  • Generate patient statements
  • Answering inbound and outbound Calls
  • Provides customer service to patients 
  • Follow collection procedures to receive the payments
  • Address billing issues and enquiries from patients
  • Setting Budget payment plans for patients.
Customer Service Cashier
June 2011 to August 2012
Payless Miami, FL
  • Maintained up-to-date knowledge of store policies regarding payments, returns and exchanges Worked as a team member performing cashier duties, product assistance and cleaning.
  • Organized weekly sales reports for the sales department to track product success.
Education and Training
Associate of Arts : Social Work, 2018 Miami Dade College Miami, FL, US  Social Work Psychology
High School Diploma : 2011 Coral Reef Senior High Miami, FL, US GPA: 3.6
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Summary
Skilled Accounts Receivable Representative with over 10 years of financial services industry. Expertly creates customized financial strategies to meet the patients needs.
Skills
  • Continuously expanding insurance and facility knowledge
  • Lead and surpass goals individually and as a team.
  • Billing for Professional and Hospital (1500 and UB04) for Account Receivable 
  • Client-focused
  • Knowledge of billing editing, and patient accounting systems
  • Strong work ethic
  • Good written communication
  • Excellent communication skills
Experience
Patient Account Representative 02/2012 Emory University Atlanta, GA Thoroughly reviewed remittance codes from EOBS/AR's. Confirmed patient information, collected copays and verified insurance. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature. Consistently informed patients of their financial responsibilities prior to services being rendered. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans. Billed all lab claims with attached lab slips. knowledge of medical billing, including third party insurance processing and be able to manage time and work assignments efficiently.
Patient Account Representative 09/1998 to 04/2011 Botsford General Hospital Farmington Hills, Mi Thoroughly investigated past due invoices and minimized number of unpaid accounts. Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information. Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Acquired insurance authorizations for procedures and tests ordered by the attending physician. Maintained an organized logging system for tracking test results. Scheduled surgeries and procedures in conjunction with Surgical Coordinator. Thoroughly reviewed remittance codes from EOBS/AR's. Confirmed patient information, collected copays and verified insurance. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature. Consistently informed patients of their financial responsibilities prior to services being rendered. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans. Billed all lab claims with attached lab slips. knowledge of medical billing, including third party insurance processing and be able to manage time and work assignments efficiently.
Sr Processor 05/1985 to 04/1994 Blue Cross Detroit, Mi Expertly planned, coordinated, organized and directed all operations of the agency. Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations. Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered. Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature. Quickly responded to staff and client inquiries regarding CPT codes. Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Thoroughly reviewed remittance codes from EOBS/AR's.  Maintained complete confidentiality in accordance with organization and legal requirements.
Education and Training
Bachelor of Science: Business Admin 2009 Universtiy of Phoenix Detroit, MI
High School Diploma: Business 1981 Mumford High Detroit, Mi