Medical Insurance

Emmylou Mercado

Email: ********@**-*******.***

Address:

City: Brooklyn

State: NY

Zip: 11235

Country: USA

Phone: 718-***-****

Skill Level: Any

Salary Range:

Primary Skills/Experience:

Driven and compassionate healthcare professional with 19 years hands-on experience in fast-paced private practices and hospital environments. Performs extensive billing and accounts receivable activities to secure optimal reimbursement for medical services rendered. Through billing system module investigates and analyzes problem accounts, post rejections, monitor payment pattern as well as preparing appeal letters, answer inquiries from patients, insurance companies and faculty practice support staff. Responds to patient's requests, updates demographics, provides feedback to the CEO on payment anomalies and offers suggestion to resolves such issues, performs other job related duties as required. Accountable and responsible with a strong focus on providing the highest quality care.

Educational Background:

High School Dipolma from University of Phoenix, Phoenix AZ 1/2001 to 1/2012 (Health Care Administration)

Job History / Details:

Professional Summary

Driven and compassionate healthcare professional with 19 years hands-on experience in fast-paced private practices and hospital environments. Performs extensive billing and accounts receivable activities to secure optimal reimbursement for medical services rendered. Through billing system module investigates and analyzes problem accounts, post rejections, monitor payment pattern as well as preparing appeal letters, answer inquiries from patients, insurance companies and faculty practice support staff. Responds to patient's requests, updates demographics, provides feedback to the CEO on payment anomalies and offers suggestion to resolves such issues, performs other job related duties as required. Accountable and responsible with a strong focus on providing the highest quality care.

Education and Training

2012 University of Phoenix Phoenix, AR

Associate of Arts Health Care Administration

Skill Highlights

Patience and self-discipline

Accountability

Motivation techniques

Conflict resolution

Analytical thinking

Leadership

Knowledge of Medicaid, commercial insurance, PPO, HMO, EPO statutes and regulations

Strong negotiation skills

Independent judgment and decision making

Medicaid Management Information Systems

Promotes positive behavior

Critical thinking proficiency

Quality improvement

Professional Experience

January 2008 to February 2012

Pamel Vision and Laser Group New York, NY

Billing Administrator

Investigates and analyzes account anomalies to secure optimal reimbursement. Led aging accounts receivable that are 90 days and over to paid accounts. Monitors payment patterns, prepares appeal letters, and responds to patient/ insurance companies inquiries. Identified process improvements in the day-to-day functioning of the department. Continually improved knowledge, skills and performance based on feedback and self-identified professional developmental needs. Responsible for physician's re-credential requirements to hospitals, and insurance companies.

April 2006 to December 2007

Scott Weissman M.D. New York, NY

Medical Biller/Surgical Coordinator

Analyzes the status of unpaid claims, troubleshooting and resolving claims for reimbursement. Ensuring collection of payment of balance dues that are over 60 days. Created special policies and procedure for past due accounts. Maintaining compliance of HMO referrals. Coordinate surgery date and requirements with surgical center and hospitals. Preparing daily bank deposits.

June 2005 to January 2006

Cornell University of Medical Sciences New York, NY

Account Receivable Specialist/Temporary Position through Agency

Identified process improvements in the day-to-day functioning of the department. Continually improved knowledge, skills and performance based on feedback and self-identified professional developmental needs.

Performs extensive billing, accounts receivable activities, prepares appeal letters. Responds to patients, insurance companies, and support staff inquiries regarding a medical claim.

January 1992 to May 2005

Steven P. Koenig M.D. New York, NY

Assistant Practice Management

Strategically planned methods to achieve operational goals and targets.

Investigated, provided and submitted information to practice managers about special incidents, events and complaints. Assisted in resolving and satisfying client requests and internal operational issues.Cooperated and communicated effectively with physicians to ensure client satisfaction and compliance with set standards. Led practice team in delivering care services that promoted optimal costumer service. Created and maintained computerized record management systems to record and process data and generate reports.

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