GRACIE RIVERA ac6wpl@r.postjobfree.com

***** ****** **. *******, ** 92337 Mobile: 909-***-****

CAREER OBJECTIVE:

Seeking a position in the Health Care Field that will offer challenges where I can apply my knowledge and skills within a company that offers the opportunity for growth and professional advancements.

SKILLS:

* Bilingual English and Spanish * Collections

* Medical/Dental (ICD-9 /CPT / HPCPS/CDT) Coding * AR/AP

* Relay * General Office Procedures

* CPSI * Answering Multi-Phone System

* Medicare DDE * Mail/Correspondence

* Medical Terminology and Anatomy * Appeal Dispute * Completions of CMS-1500/UB-04 * Great Organization Skills

* Insurance Verification/Authorization * Extremely Detailed

* MS Word, Excel, MS Outlook * Posting/Processing of Payments

* Internet for eligibility website * Data Entry, Type 45 WPM

* Homecare Homebase billing

* Schedule, Coordinate, Monitor Patient Appointment

EDUCATION:

2005/2006 Franklin Career College/Medical Billing and Coding Program Ontario, CA

* Awards Received: 4.0 GPA/Perfect Attendance

Prime Healthcare Services Medical Biller-Collector/Customer Care Representative

Ontario, CA

02/2013 – 7/2018

Hospital Business Services duties: Submit billing data to insurance providers, resolving billing inquires with private health insurance companies. Performed administrative tasks around the office: Answering incoming phone calls from patients, insurance companies, making copies, faxing documents, ect. Collect on open balances from Aging report, review to ensure reimbursement was paid accurately and in full. I am often checking status of claims that intel a lot of outbound calls to a variety of insurance companies. I review correspondence, re-bill, correct claims, and most often send out reconsideration request. When accounts are, delinquent or denied I submit appeals and disputes to their grievance department. As far as claims being reimbursed I have a high turnaround, that I record for future denied claims that I can then refer my prior overturned accts. And cross reference with the templates and language I used to overturn that claim and utilize how I can go about another.

T & T Staffing (Inland Empire Health Plan) Enrollment Administration

San Bernardino, CA

Date Employed: 10/2012- 2/2013

Duties: Answering high volume of calls through Client Desktop queue, taking messages and re-routing calls to various departments as well as making outbound retention calls to members. Assisting Enrollment Advisors with duties as follows: Completing Medi-Cal Choice Forms which is done by data entry, assembling Pre-Enrollment kits for the Healthy Families, Medi-Cal and Healthy Kids Programs as completed by CAA’s (Certified Applicant Assistors). Making copies, faxing documents other various administrative duties as assigned. Data entry done daily through the Goldmine Database, and all Medi-Cal choice forms were completed on a fillable PDF My Medi-Cal Choice Form and I am responsible for over 1,000 forms per month.

Primary Care Medical Group Medical Biller & Collector San Bernardino, CA

Date Employed: 5/2010- 10/2012

Duties: Data Entry, answer multi-phone line, routing calls to various employees, make appointments for various Doctors, Medical Billing ICD9/CPT Medicare, Medi-Cal, PPO, HMO, Sleep Study Billing, Collections, appealing denials for Sleep Studies, internal medicine, and pediatrics. Administrative duties, Verifying Medical Insurance over the phone or thru their websites, interpretation of EOB’s, on-line billing through I.E.H.P, I.F.M.G-Molina (P4P) and other websites, entering co-pay payments, solving patient complaints over the phone and in person, input patient demographics.

Medix Careers (Loma Linda Medical Group) Administrative Assistant

Loma Linda, CA

Dates Employed: 12/2009-4/2010

Temp - Duties: Data Entry, Medi-Cal, Medicare, CCS, input and follow up on TAR’S (treatment authorization request) and SAR’S (services authorization request). Update and summit enrollment issues with providers, and clerical duties.

Arrowhead Community Surgical Medical Group

Redlands, CA

Dates Employed: 5/2006-8/2008 Medical Biller

Duties: Data Entry, Medical Billing; Medi-Cal & Medi-Care, Private Insurance (HMO, PPO) Workers Compensation, Verifying Insurance over the phone or thru their website, Collections, E.O. B’s, Appeals, Denials, Negotiation with Insurance Companies, setting up payment plans with patients, faxing, filing, calling patients and posting payments.

REFERENCES

References upon request

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