SEAN MARTINEZ

Hawthorne, CA ***** H: 310-***-**** C: 310-***-**** acug83@r.postjobfree.com

Professional Summary:

Experienced billing and collections director with more than 16 years of self-pay and medical collections, and over 6 years of managing medical billing with proven success in operations, and business development strategies, project and staff management, ad hoc reporting, journal and ledger entries, proper billing and coding procedures, and maintain knowledge of payor billing requirements

Proven track record reducing delinquencies and bad debt, maximizing recovery, monitoring billing and collections tracking trends, improving quality assurance, hiring and developing loyal and top performing qualified candidates, improving training and staff development, increasing morale, and decreasing turnover

Exceptional communication skills, detail oriented, dependable, easily interact with executives, clients, and staff, and able to make decisions, allocate resources, and manage time efficiently

Proficient in collections for outpatient setting, hospital, dental, government, commercial, retail, utility, subrogation, Medicare, Medi-Cal, indemnity, traditional, managed care, self pay, claim resubmission, and appeals all for cardiac rehab, general practice, and pharmaceutical billing

Knowledge with FDCPA, Trans Union, Equifax, Experian, Dunn and Bradstreet, insurance terminology, EOB interpretation, Posting, CPT coding, ICD-9, HCPCS, NPI Federal Register overview, NPPES, NUCC, NCPDP, HIPAA, HITECH, OIG, FWA, Medi-Span, First Databank, Redbook, Gold Standard, PBM contracts, business associate agreements, insurance verifications, prior authorizations, and appeals

Efficient in PC based software programs like Excel, Word, and Outlook along with collection software systems like Columbia Ultimate, Collect One, Collect, Medisoft, and Lytec

Familiar with power dialers, skip tracing tools, liens, and deeds of trust

Education: Wauseon High School Wauseon, OH

Graduated 1988-1991

American Academy of Professional Coders

Certified Professional Coder 2009

Professional Experience:

Global Cardio Care Inglewood, CA

DIRECTOR OF CENTRAL BILLING OFFICE 03/07 – 10/09 & 05/13 – 01/16

Direct a team of 7 (manager, biller, coder, 2 verifiers, and 2 collectors) for an outpatient setting including lab and diagnostic testing facility for Medicare, Medi-Cal, PPO, HMO, and POS claims

Responsible for directing the billing and coding for two providers, and two locations processing some 160-180 claims daily while maintaining 95% accuracy

Coached and developed team through side-by-sides and follow-up critique on calls completed to improve technique; utilizing individuals strengths within group; provided feedback and suggestions during and after calls

Improved collection efforts by identifying, analyzing, and recommending problems found to increase collection recovery percentage, and billing efficiency

Implemented, and held team accountable for compliance with government, and third-party payor regulations including participating with payor, state, and accreditation audits when they occur

Assist patients with resources and options concerning settlements, reductions and debt maintenance

Acquired Certified Professional Coder Certification to validate codes based on national coding guidelines

Duties also include overseeing verifications, pre-certifications, medical records, tracking for cancelations and rescheduling, preparing letters of medical necessity, and helping with member appeals

Grant & Weber Calabasas, CA

COLLECTION MANAGER 04/12 – 05/13

Managed the re-organization of 3 departments of 50 collectors including training staff, evaluating collection process, and making recommendations for improvement for self-pay, hospital, and outpatient collections

Spearheaded numerous new policies/procedures in the reorganization and teamed with IT to implement new dialer software to manage the mass collections

Assisted the CEO, COO, and CFO in developing targets, and issuing reports on a regular basis to inform of our progress towards goals including assisting with implementing changes to queues and workflow to improve efficiency and coverage

Automated reports that for the first time measured and tracked all disputes allowing for creation of a Collector incentive program to ensure maximum performance and staff feedback, while also reducing 120 plus day aging by 30%

Created collection initiatives that doubled credit card payments, while providing extensive training to the staff of fifty

Complete Claims Processing, Inc. Los Angeles, CA

COLLECTION MANAGER/PHARMACY CONTRACTING MANAGER 10/09 – 02/12

Managed hiring, training, performance, and evaluation for 3 departments and 8 staff members for over 30 million dollars of accounts receivable for over 100 Non Pharmacy Dispensing Sites

Developed, prepared, coordinated, and implemented maximum reimbursement and contract structures while providing related reports in a timely manner along with restructuring overall review of proper patient insurance billing and reconciliation requirements

Coordinated all activities for collections department and lead a team of productive employees while partnering with our billing department to improve efficiency on the front end which increased 30% more revenue

Initiated, acquired, reviewed, analyzed, and managed pharmacy contracts with 24 pharmacy benefit managers for individual and chain agreements for all of the Non Pharmacy Dispensing Sites

Solved complex problems and developed innovated solutions for collections, pharmacy contracting, and constructed a HIPAA/HITECH data management department to manage all mail including EOB’s, checks, demographics, Rx forms, medical records, DEA’s, certificate of liabilities, and state licenses

Maintained network composition, strong business relationships with physicians, and ongoing professional relationships with pharmacy benefit managers

Exclusive Debt Recovery Group Vernon, CA

SR. ACCOUNT EXECUTIVE 10/03 – 05/07

Oversaw most operational matters for start up collection agency, in particular management of 4 employees.

Responsible for creating, formatting, and development of collection policies and procedures as well as strategic planning for corporate accounts which included over 2 million dollars in new business

Organized and conducted full operations training, from FDCPA regulations to direct client relations

Increased productivity year by year by leveraging skip tracing and collection abilities to build credibility

Continuously worked on improving processes and policies to improve collection recovery rates while meeting projections and goals.

Worked with local chamber of commerce as Ambassador

Sequoia Financial Services Glendale, CA

SUBROGATION COLLECTIONS SPECIALIST 07/02 – 10/03

Managed the task of collecting on total loss, fraud, and property damage claims for 21st Century, Bristol West, and Farmers Insurance by way of utilizing vehicle codes, police reports, skip tracing, and investigations

Performed fair disposition of both routine and complex physical damage claims

Coordinated all claims payments and benefits among multiple insurers in an organized, reliable fashion

Demanded documentation and created surveys to realize the liabilities of all parties involved in a claim

United Collection Bureau Inc. Toledo, OH

COLLECTIONS RECOVERY SPECIALIST 10/98 – 07/02

Supervised the collection of delinquent medical, utility, and retail bills for inbound and outbound call center while working in a power dialer system

Performed financial counseling for third party reimbursement issues such as balances exceeding expected reimbursements from commercial, managed care, Medicaid, and Medicare

Assisted patients and debtors with resources and options concerning settlements, reductions and debt maintenance while securing payments of self-pay claims in order to regain credit

Maintained FDCPA regulation and compliancy

Incorporated corporate vision by utilizing maximum recovery for high client base in Ohio, Michigan, Pennsylvania, and Florida area.

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