DORIS MENDEZ

484-***-**** (Cell)

Email: ac7aay@r.postjobfree.com

** ******* **.

Apt. 4

Hudson, MA 01749

OBJECTIVE

Utilize my existing working capacities, professional skills and business efficiencies. Serve my organization in the best possible way with sheer determination and commitment. Through my past experience and my proven track record I know I can contribute to the growth of your organization.

SUMMARY OF QUALIFICATIONS

Maintain the highest quality of customer service. Knowledge of financial and accounting principles and procedures as related to collections, accounts receivable and payable. Ability to gather and analyze complex information, data, compile information, solve problems and prepare reports. Assist with direct patient care as a Medical Assistant. Self-motivated with the ability to work well independently and as part of a team environment with minimal direct supervision

I have excellent communication skills in both English and Spanish Languages.

PROFESSIONAL EXPERIENCE

HealthDrive Corp. Wellsley, MA 10/16 - Current

(HealthDrive: Provides on-site Dentistry, Optometry, Podiatry and Audiology services to residents in long-term care.)

Reimbursement Specialist/Biller

Charge entry: enter charges, procedure and diagnosis codes and pertinent provider information needed to generate a new claim for Optometry and Podiatry services.

Billing, resubmission of claims and appeals to Medicare, Hospice, Medicaid, BCBS, Commercial, Third Party Administrators, Skilled Nursing Facilities and Rehabilitation Centers.

Work electronic & paper denials/rejections. Identify, investigate and make follow up collection calls to insurance companies to expedite resolution of denied and or unpaid claims. Process refunds, submit w/o or adjustments

Work directly with Regulatory Affairs to ensure that providers are billing with the correct codes and are compliant with CMS Guidelines. Proof of treatment & medical records are sent directly to RA for any changes made by a provider. Changes such, as a patient’s name, date of birth, treatment date, removal or addition of a modifier, CPT or ICD10 codes or facility location. Once changes are approved, I update and released claims to the insurance for payment.

Verification of benefits, obtained precertification for treatment.

VAC (Vascular Access Centers) Philadelphia, PA 05/16 – 10/16 A/R Account Manager

Proactively resolve issues with insurance payers, Medicare and BCBS being the biggest payers.

Research denials on patient accounts.

Correct claim errors and resubmit claims, claims edits, MUE’s, coding, charge entry.

Send supporting documentation required by insurance companies.

File appeals and reconsiderations, mostly to Mcare; educate centers on the correct policies and procedure for billing.

File secondary claims with primary EOBs, cash posting, write offs, refunds.

Perform various collection actions including contacting patients by phone.

Monitor customer account details for non-payment, delayed payments and other irregularities.

Perform miscellaneous revenue department projects as assigned by Director or Team Leader) other duties as assigned.

Synergy Orthopedics (DME/Orthotics) Plymouth Meeting, PA 05/13 – 02/16

Medical DME Biller/Collector Specialist

Charge entry, coding and submission of claims to Medicare, Medicaid, BCBS, Commercial, Workers Compensation, Auto Carriers, Third Party Administrators, Skilled Nursing Facilities and Rehabilitation Centers.

Follow up on unpaid claims within standard billing cycle timeframe; check each insurance payment for accuracy, discrepancy and compliance with contract discounts or negotiated rates.

Verify coverage & benefit information via provider portal or by contacting the payer directly.

Obtain referrals, authorization/precertification and purchase orders for treatment when required via provider portal or through direct contact with insurance carriers.

Cash posting, provider adjustments, process refund request, resubmission of corrected claims and claims appeals.

Provider disputes and appeals for claims that were not paid according to fee schedules or negotiated rates.

Work the patient inbound call center, offering discounted rates or monthly installments (final bill) due to financial difficulties. Appeals: mostly to Medicare (reconsiderations, reopening, redeterminations & ALJ)

Manage the facility's Accounts Receivable reports as assigned. Negotiate rates with TPA, Repricing Units, Bill Review, Utilization Management; discounted rates are based on Medicare fee schedule, Workman’s Compensation’s State fee schedule, contracted and out of network rates.

Direct contact with Workman’s Compensation and Automobile claims adjuster to verify policy coverage, date of accident or date of injury, if benefits have exhausted or reached the lifetime max, also obtained precertification if required by state.

Obtain medical records and documentation needed to support reason for medically necessity from Orthopedic Surgeons (treating providers), Orthotic Fitters and Orthotist, review medical records to make sure the criteria has been met and supporting documentation is on file for DME billing.

Fill in for Team Lead who was out on a maternity leave of absence. Trained new employees.

Volpe Express (Trucking Company), Phoenixville, PA (Temp. to hire) 12/12 – 01/13

Collector/Accounts receivable

Cash posting, monitored assigned accounts to ensure aging balances were not 30 days past due.

Verbal and written communication with customers and internal departments to resolve billing issues.

Investigated discrepancies and following-up on outstanding balance invoices.

Collection calls on past-due invoices.

Obtained purchase orders from clients for services performed.

Aesbar Medical/Med Supply Cabinet, Harleysville, PA (Temp) 07/12 – 10/12

Collector/Biller (Durable Medical Equipment)

Managed patient accounts, worked accounts to verify payments and billing were been done correctly.

Kept DOS balances down, performed verification of benefits, obtained pre-certifications and referrals when needed and obtained medical record documentation to support a service and to prove reason for being medically necessary.

Worked with Customer Service Representatives on issues dealing with patient accounts, spoke with patients/customers about billing problems or questions.

Life Counseling Services/Rehab After Work, Paoli, PA 02/11 – 07/12

Collector (Behavior Health Services)

Maintained a quality standard of all billing and collection functions at all times.

Provided support to internal and external financial centers on reimbursement related issues.

Submission of behavior health claims to various contracted payers.

Obtained payment for Intensive Outpatient Programs (IOP), Outpatient Group Therapy & Individual Therapy services.

Worked directly with Site directors, Group Therapist and Licensed Physicians to ensure correct clinical documentation was provided to the different payers so that precertification could be obtained for our services.

I demonstrated high levels of interpersonal skills, complied with HIPPA regulations with respect to highly sensitive and confidential data with clients and clinicians.

Worked a monthly aging report and unapplied cash report to clean up account cash > 30 days.

Worked the inbound call center to assist clients with eligibility and benefits, account balances, refund request and claims disputes.

National Vascular Care (Dialysis Co) Rosemont, PA 11/08 – 12/09

Patient Accounting Representative

All aspects of medical collections, account responsibility.

Claims submission to Medicare, Medicaid, Commercial and Government Insurance carriers.

Review credit balances, refunds, adjustments, cash posting and claim denials.

Bryn Mawr Aesthetic Plastic Surgery, Bryn Mawr, PA 10/07 – 11/08

Billing Manager

Prepared and instituted policies and procedures in such areas as scheduling, registration, billing, and collections.

Oversee adherence to these policies and procedures. Serve as back-up coverage for the Business

Manager.

Responsible for Account Receivables, balanced of daily ledgers.

Entered charges, procedure and diagnosis codes into the system for emergency room, wound care and reconstruction procedures which also included cosmetic surgery.

Obtained precertification’s for surgical procedures.

Compliance officer, Credentialing

Medical Assistant (Prn)

All medical assistant duties which included, obtaining patient history, assisted with minor surgical procedures. Provided wound care and suture removal.

Ordering and stocking of supplies, sterilization of instruments.

Called in prescriptions, requested refills and performed reception desk work.

DaVita Inc. (Dialysis Co) Berwyn, PA 09/00 – 06/07

Senior Collector/Biller

Responsibilities included leading a team of 8 collectors and coordinating their daily job functions.

Train new and existing employees, approved adjustments, researched and approved refund.

Assisted collectors with troubleshooting problematic payers.

I approved the resubmission of corrected electronic and paper claims within a timely filing. Group collections average per month 125%.

Collector/Biller

Medical collections, account responsibility, billing and claims submission to Medicare, Medicaid, Commercial and Government Insurance carriers.

Per-Se' Technologies, Trenton, NJ 12/97 – 09/00

Medical Billing/Customer Service Rep

Processed claims, third party and patient billing for Emergency Room Physicians.

End of month close.

Occupational Health Services, Pennsauken, NJ 10/95 – 07/97

Billing Supervisor

Processed claims for Workers Compensation, Motor Vehicle, and various Commercial Insurances.

Settlement negotiations between Attorneys, Insurance companies on behalf of the Physician.

Accounts receivable. Performed follow up calls to delinquent account holders with a 90% successful payment rate.

Spanish interpreter during numerous settlement negotiations between Attorneys, Insurance companies and between the Physician and his patients.

Medical Assistant (Workers Comp. & Motor Vehicle) 05/91 – 09/92

Front and back office duties, scheduling appointments and answering phones.

Assisted with medical exams and performed Cardiac Stress testing for the New Jersey State Division of Disability department. Spanish Interpreter.

Assisted with minor surgery and provided physical therapy treatment to patients.

Performed phlebotomy, collection of specimens, routine and NJDOT drug screens, EKGs, Audiometry, Spirometry, Cardiac Holter monitor, vision testing and company physicals.

Ordering and stocking of supplies, sterilization of instruments.

Various Healthcare Providers (OB/GYN, Internal Medicine, Family Practice and Allergy Medicine

Louisiana & New Jersey 06/87 - 8/98

Medical Assistant

All aspects of medical assisting and billing.

Education

Program (Certified in CPR)

Montgomery County Community College, Blue Bell, PA - Working towards a degree in Business Management

Commercial College, Shreveport, LA - Medical Assistant Program: Certificate

Mohawk Valley Community College, Utica, NY - Central Supply Technician: Certificate

American Red Cross, Griffiss AFB, Rome, NY - Dental Assistant: Certificate

Eugenio Maria de Hostos High School, Mayaguez, Puerto Rico – Diploma

Balboa High School, Canal Zone DOD, Panama

Skills

Functional knowledge of insurance companies and claims information

Knowledge of Medical Terminology

ICD-9-CM/ICD-10 andCPT-4 Coding,

Excellent negotiation and critical thinking skills

Excellent technical, accounting and communication skills (internet navigation)

Microsoft Office

Time management and attention to detail

VGM Education/VGMU Online Learning (Yearly)

Billing and Reimbursement

HIPPA Laws

Customer Service

Introduction to CMS and Medicare

Contact this candidate