Insurance Collections and Appeals or Denials
Resume:
Brenda
Vivar SUMMARY
I consider myself to be a multi talented, fully bilingual person who is looking for an opportunity
to grow and not just another job. Very successful and highly experienced reconciling
12808 Q ueensbury insurance/patient payments and resolving account disputes. Proficient in a variety of practice
Lane management applications and EHR software. Dedicated to maintaining strict patient
Unit E507 confidentiality. Excellent organization, communication and relationship building skills.
Houst on, Tx. 77024 Productive, analytical thinker and innovative problem solver. Highly trained in all aspects of
insurance billing, claims and collections. Employs a high level of negotiation skills in
resolving claims to the satisfaction of all involved parties. Outstanding customer service skills,
resolves a wide variety of customer service issues quickly and efficient.
v iv ar br endam@gmail.c om
MAJOR QUALIFICATIONS
● Over seven years of hands on experience working in Billing and Coding field
● Extremely familiar with medical terminology
● In depth knowledge of preparing appropriate claim documents
● Able to perform charge review, claim submission, claim follow up, payment posting
and patient statements
● Bilingual (verbally and written)
● ICD 9, ICD 10, CPT & Medical Terminology
● Diverse Medical Insurance Billing (Online and Paper)
● Well versed in Government/Commercial insurances
● Excellent Interpersonal Skills
● Exceptional telephone etiquette
● Various Practice Management Software
● Claim Entry (Electronically, Online and by Paper)
● Online and telephone Insurance eligibility verification
● Auditing methodology
● Records Organization & Management
● Insurance & Receivable Aging Management
● Strong time management, Skills prioritizing tasks and meeting deadlines
● Dependable work ethics with impeccable attendance
● Medical Office Administration
● Appointment Scheduling
● Medical Office Procedures
TECHNICAL PROFICIENCY
● Proficient in creating, editing, annotating, assembling and sending PDF files
● Word Processing and Spreadsheets (Microsoft Word,Google Docs for
Business,Google Sheets, Libreoffice, Openoffice)
● E Mail Software (Google apps for business, Yahoo, Windows, Hotmail)
● Financial Software (Vend, Xero, Stripe and Merchant Ware, Authorize.net)
● Cloud Storage (Dropbox, Box.com, Microsoft One Drive, Google Drive (Vast
knowledge of uploading, editing and manipulating files in the box
● Browser (FireFox, Internet Explorer, Google Chrome) Extended Dual Screen
Monitors and Internet software proficient.
● Medication Prior Authorization Software ( Covermymeds, Availity, Express Scripts,
Navitus, PA Xpress)
WORK EXPERIENCE:
Medical Insurance Billing and Coding
Integra Behavioral Health Care
H ouston, Tx . 2005 Current
INSURANCE BILLING AND CODING
● Inc reas e rev enue for prov ider with s ame patient load
● Ex perienc e in billing for Subs tanc e Abus e, Mental/Behav ioral Health and
Ps y c hotherapy Spec ialties
● Ens ure ac c urac y of ins uranc e c laims,v erify c orrec t ICD 9/ICD 10 and CPT
c odes
● Set up prac tic e management s oftware for s ubmis s ion of elec tronic c laims to
c learinghous e
● Work with c learinghous e to res olv e file c ompatibility is s ues
● Ins uranc e pay ments guaranteed to be proc es s ed immediately and prov ider will
rec eiv e ex tremely quic k EFT depos its with a pay ment turnaround time of 7 10
day s max
● Chec k pos tings and doc uments for c orrec t entry, mathematic al ac c urac y and
proper c oding
● Ens ure c harting ac c urac y through prec is e doc umentation.
● Unders tand ins uranc e guidelines inc luding Medic are and other gov ernment,
priv ate, s elf ins uranc e, and managed c are plans
CLAIMS PROCESSING AND ACCOUNTS MANAGEMENT
● Proc es s an av erage of 450 to 700 c laims /s tatements monthly for Ps y c hiatric
and Ps y c hotherapy Outpatient Offic e
● Ens ure c laims are entered and s ubmitted within 24 to 48 hours of rec eipt
● Send s ec ondary ins uranc e c laims upon proc es s ing of primary ins uranc e.
● Follow up on Ins uranc e and patient aging
● Re s ubmit ins uranc e c laims as nec es s ary .(Well v ers ed with timely filing
res tric tions )
● Retriev e Elec tronic Remittanc e Adv ic e (ERA)
● Res earc h and res olv e billing and inv oic e problems
● Res earc h and res olv e inc orrec t pay ments, EOB rejec tions, and other is s ues
with outs tanding ac c ounts
● Identify and res olv e dis c repanc ies and c laims delay is s ues that impac t billing
and c ollec tions
● Ac c urately apply pay ments to patient ac c ounts
● Pos t and rec onc ile ins uranc e pay ments
● Set up new patient ac c ounts,v erify,edit and modify members information.
● Monthly proc es s ing of patient s tatements, ans wer and res olv e patient billing
inquiries
● Manage ac c ounting operations, ac c ounting c los e, ac c ount reporting and
rec onc iliations
● Adminis ter end of day c as h box c los ing
PATIENT SERVICES
● Res olv es a wide v ariety of c us tomer s erv ic e is s ues quic k ly and effic ient
● Intak e and res olv e patient ins uranc e reques ts, v erific ation, billing, c opay and
balanc e is s ues
● Intak e and proc es s (Inc lus iv e of elec tronic pay ments ) all patient refill reques ts
● Ex plain billing polic ies and/or ins uranc e c opay ments to c us tomers
● Strong ability to interac t and effic iently c ommunic ate with people ov er the
telephone, often in s tres s ful s ituations
● Res earc h and res pond (by telephone and in writing) to patients inquiries
regarding billing is s ues and problems
● Perform a v ariety of general c leric al duties, inc luding telephone rec eption, mail
dis tribution, and other routine func tions .
● As s is t in preparing doc umentation and res pons es for Ins uranc e Audits, Court
Subpoenas, Pending Cus tody Cas es, CPS/Fos ter Children Pers onnel and/or
repres entativ es
● Perform Patient Vitals and enter in patients EHR
● Res earc h patients des ired pharmac y and entered in patients EHR in order to
E Pres c ribe
● Intak e, c hec k in and c hec k out patients for rec eption
● Pers is tent to ans wer all inc oming c alls (Av erage Prac tic e Call Volume 250
daily )
● Ability to s c ribe for medic al doc tor
PRESCRIPTION MEDICATION ASSISTANCE
● Proc es s medic ation prior authoriz ations for ins uranc e approv al
● Initiate appeals to their c orres ponding ins uranc e (online and by phone)
● Create Medic al Nec es s ity Letters
● Proc es s, rev iew, res earc h and approv e medic ation refills reques ted through
patients pharmac y
● In depth k nowledge of Mental and Behav ioral Health Medic ations Formulated
from Sc hedule I to Sc hedule V c ontrolled s ubs tanc es
● Coinc ide with the Pharmac eutic al Repres entativ es in order to prov ide the
offic e with their medic ation s amples .
● Vas t k nowledge of pres c ription abbrev iations
● Aware of pres c ription requirements and guidelines
● Adminis ter patient referrals and Coordination of Benefits to other prov iders
● Prov ide patient as s is tanc e/c oupon information when appropriate
COMPLIANCE
● Ens ure offic e prac tic es doc uments are in c omplianc e with HIPAA regulations
● Manage medic ation s upply inv entory, ins uranc e rec ords, patient c harts and
c ompany files
● Superv is e and train rec eption, billing and c ollec tion s taff
● Coordination of all Pharmac eutic al Repres entativ es Medic ation Samples and
c oinc iding medic al Doc tors Lunc hes
● Ability to pull PATS Sy s tem Report through the Tex as Department of Public
Safety in order to rev iew and c onfirm patient's pres c ription his tory to determine
of any medic ation abus e
REFERENCES
Gent il Salaz ar MD PA
Child and Adoles c ent Ps y c hiatris t
Das s y Salaz ar DDS
Cos metic and Orthodontic Dentis try
Adan Ramirez Atriham MD
Facility Medical Director at First Choice ER
Dirc e Ortiz LPC
J os eph Coleman LCSW
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