Annie Perlas-Rodriguez

*** ***** ***** *** #***

Alameda, CA. 94501

510-***-****

SKILLS: Medical Billing, Medical terminology, ICD-9 diagnosis coding,

RBRVS/CPT, HCPCS Procedure, Bookkeeping, Typing 50

wpm, 10 Key by touch.

FUNCTIONAL AREAS AND EXPERTISE:

. 10 years experience with account management, review and process complex

providers billing and collections specific to PPO, HMO, and Government

payers.

. Reviewed Workers Compensation claims and processed according to the

California fee schedule

. Excellent analytical and problem solving skills with medical collection

issues.

. Strong written and verbal communication skills.

. Able to recognize patterns with billing, registration and interface

systems, that impact reimbursement.

. Organized and detail-oriented; efficient with emphasis on quality of

work.

. Strong customer service skills. Experience working with patients,

physicians, vendors, and hospital staff at all levels.

. Excellent computer skills. Experience with Microsoft Office, SMS, IHS,

IDX, STAR HBOC and Medi.com. SSI, Sunrise, Epic

The Plus Group, Inc. - (Assignment ) John Muir Med Cntr 01/2012 - 04/2012

Patient Account Representative/ Behavioral Health Claims

Alta Bates Summit Medical Center 07/2007 - Present

Admitting Representative

* Interview patients / family to obtain the required patient and

guarantor demographic and insurance information.

* Accurately and efficiently enter this information into the Patient

Registration system.

California Pacific Medical Center 11/2006 - 07/2007

Patient Account Representative

Aptium Oncology - Contracted with Alta Bates Comprehensive Cancer Center

12/2000 - 04/2006

Patient Account Representative

. Ensure that all patients and third party payers reimburse the ABCCC

timely and accurately based on benefits verification and contract terms.

. Initiate telephone contact with patients and third party payers to obtain

specific claim resolution information.

. Assist patients with understanding their insurance, review bills and

research problems.

. Coordinate with patients on self-pay accounts, co-pays and balances in

order to collect payments.

. Respond to all third party payer requests for medical/financial

information to support the appropriateness of the claim under evaluation.

. Periodically review all credit balances. Initiate refund requests to

ensure compliance with contractual provisions and organizational

guidelines.

. Advise and/or perform registration corrections of all accounts for

insurance updates and adjustments.

. Determine accounts ready for assignment to outside collection agency or

agencies.

. Appropriately identified and challenged denials to maximize cash

collections.

Marcon Group Inc 11/1998 - 11/1999

Medical Billing Processor

. Review Medi-Cal / Medicare documentation for completeness against payer

guidelines.

. Work with nursing staff to finalize documents.

. Verify eligibility for new Medi-Cal patients.

. Process TARS and expedite prescriptions and certificates of medical

necessity from MD's.

. Complete daily reports and attach copy of adjudicated TARS received.

. Track-Part A-100 day's expirations and monthly insurance authorizations

for renewal.

Intracorp/Accumed - 02/1988 - 11/1990

Corvel /Medcheck - 12/1990 - 12/1991

Genex Services - 07/1993 - 02/1996

Workers Compensation Representative

. Reviewed workers compensation claims and processed according to the

California fee schedule.

. Reviewed pharmacy, and hospital inpatient and outpatient bills for proper

codes. Convert CPT numbers to RVS code; convert the diagnosis to ICD-9

code.

. Code and audit claims in a timely manner, make sure the bills

recommendations are correct.

. Worked with med-legals and consultations, surgery, and physical therapy

bills.

. Reviewed chart documentation and assessed payments based on the level of

care documented.

Education:

1986 - 1987 Southwest College, San Francisco, CA

DATA ENTRY - Completed course and received

certificate.

1977 - 1980 University of Negros Occidental, Recoletos, Philippines

Typing class, Psychology, Accounting

Contact this candidate