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Resolutions Specialist II, Customer Service, Account Reconciliation

Location:
Floresville, TX, 78114
Salary:
$25/hour
Posted:
March 21, 2018

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Resume:

Professional Summary

Skills

Work History

REBECCA DE LA GARZA

*** ****** *** **, ***********, TX 78114 (C) 210-***-**** ac4vpm@r.postjobfree.com Exceptional leader talented at Account Reconciliation, Customer Service and Healthcare Billing. Team player, detail-oriented, good organizational skills, calm professional demeanor, and excellent telephone skills. Customer satisfaction focused-both internal and external, and able to handle difficult customer situations.

Data management

Proficient in Microsoft Office products

Extremely organized

verbal and written communication

Excellent reconciliation skills

Self-motivated

ICD 9

Claims Knowledge

Responding To Patient Phone Calls

Account Auditing

Excellent reconciliation skills

Self-motivated

ICD 9

Data management

Proficient in Microsoft Office products

Extremely organized

verbal and written communication

Insurance Follow-Up

Research

Resolution Specialist II 03/2015 to Current

KCI USA, Inc – San Antonio, TX

Review, analyze denial and no response Accounts Receivable and Order entry exceptions and discrepancies to ensure accurate invoicing and prompt payment within KCI business practice and time sensitive guidelines.

Performs extended resolution activities on more extensive exceptions and discrepancies including engaging parties such as Finance Department, National Contact Center, Contracts Area and KCI USA field staff to collect necessary transaction details required to advance the information systems to identify and remove barriers to account collection. Facilitates high volume, extensive professional level verbal and written communications to a broad spectrum of internal and external contacts during all resolution activities operating within strict federal credit guidelines and in full compliance with Sarbanes-Oxley regulatory requirements. Researches and verifies all requisite specific transactional information such as contractual stipulations and service dates, initial order entry information, purchase order information, contracting information such as price breaks.

Supervisor, Billing/EDI Department 01/2014 to 03/2015 KCI USA, Inc – San Antonio, TX

Responsible for the billing of electronic and paper claims ensuring HIPAA compliance. Daily reconciliation of claims to the clearinghouse. Work, resolve, and rebill electronic claim rejections. Analyze and prioritize workloads based on department inflows to meet company expectations. Sets expectations and hold team members accountable. Creates an environment that promotes professionalism, engagement and inclusion. Provided instruction, coaching and motivation to all employees to effectively reach department goals.

Monitors employees and department performance on key performance indicators. PFS Billing Team Leader 10/2012 to 01/2014

KCI USA, Inc – San Antonio, TX

The team lead is the first line of leadership within the organization. Provide backup assistance for claim validation through SSI ClickOn system for Electronic Data Interchange (EDI) processing.

Initiates account resolution with other KCI departments pertaining to claims billing. Provide backup assistance for Medicare and Secondary claims billing. Assess training needs of Billing Specialists and provide guidance and training on department processes and procedures.

Covers team operations for Supervisor when needed. Billing Specialist I & II 08/2006 to 09/2012

KCI USA, Inc – San Antonio, TX

Validated electronic claims file to submit to payers. Researched and resolved level 3 error rejection reports. Reviewed payer websites, contacted payers, patients, and physician offices to obtain the necessary information to resolve the issue, re-filing claim in a timely manner. Utilizing Workflow Applications to Resolve rejection issues that involve updating billing rules, and other EDI issues.

Backup person for web portal claims filing.

Helped review claim-stat reporting and technical denials. Placed in charge of the NPI project for KCI. Assigned to registration of NPI numbers for KCI service centers and physicians prior to the NPI deadline

Education

Accomplishments

Supervising a staff of four individuals.

Contacted the top 200 payers to register KCI's NPI numbers and update the billing system. Bachelor of Arts: Accounting with a Specialization in Information Systems October 2017 Ashford University - San Diego, CA

Graduated Cum Laude

Student Mentor

The mission of the CHAMPS Peer Mentoring Program is to provide opportunities for Ashford University students to have access to the knowledge and experience of successful peer mentors to promote student success.



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