Medical Technician

QUEENCY ABAD, RHIT

**** ******** **, ********, ** 91770 H: 626-***-**** C: 626-***-**** *********@*****.***

PROFESSIONAL EXPERIENCE

**** ********** ******** - *** *******, CA November 2002 - Present

Billing Supervisor

• Supervise a team of staff in handling numerous CMS audits; ensuring that audits are processed in a timely matter and complete/accurate medical records are submitted.

• Adjudicate DME claims, Medical crossover claims, third party crossover claims and secondary payer claims.

• Appropriately and correctly identify errors/problems, correct errors/problems, and re-file denied/rejected claims to insurance companies.

• Request for claims appeals, redeterminations, provider disputes, reconsiderations and prior authorizations.

• Verify patient information, and confirm proper insurance coverage of new transplant patients. Collaborate with transplant coordinators to discharge newly transplanted patients, and/or help patients with high copayment issues or insurance problems.

• Coordinate with discharge planners/social workers/case managers regarding resolving claims issues and discharging patients with general/maintenance medications.

• Supervise billing associates to ensure accuracy of applied payments and adjustments from Medicare, Medicaid, HMOs, and other insurances.

• Assist pharmacy technician processors in processing denied claims by explaining rejection messages and explaining coverage/billing criteria.

• Act as a reimbursement information resource for staff, patients and nurses. Assist co-workers, patients, transplant coordinators, staff from clinics, with questions they have regarding coverage, reimbursement and medical necessity.

• Monitor Medicare part B claims submission. Ensuring that every DME claim submitted is accepted by CEDI and received by Medicare.

• Monitor payment activity. Check all claims submitted are paid. Check for non-payment. Resubmit non-paid claims. Maximize the billing and collections efforts for payment.

• Review and revise billing procedures as needed and continually communicate changes in coverage issues. Keep up with reimbursement procedure changes.

• Meet with auditors regarding claims reviews. Meet/speak with different insurance company representatives regarding submission problems/claims error/improvements.

• Coordinate and help resolve pharmacy software and Medicare billing software issues

• Prepare reports that show metrics regarding payments and denials and recommend improvements to management as necessary.

• Manage office expenses and expenditures

St Vincent Medical Center - Los Angeles, CA Feb2013 – May 2013

Health Information Management Department

HIM Student Intern

• Conducted medical record audit and medical record chart assembly

• Processed Release of Information

• Notated receipt of correspondence to patients account.

• Attended tumor board meetings, medical records meeting, CDI steering committee.

• Shadowed HIM Director, Quality Improvement Manager, and Revenue Cycle Director.

Hygeia Apothecary Inc - Los Angeles, CA Aug 1999 – Oct 2002

Pharmacy Technician – Pharmacy Clerk

• Filled bottles/cassettes/bubble-packs with prescribed medications and affixed labels.

• Received written prescriptions and refill requests from dialysis centers and SNFs.

• Processed prescriptions to PBMs

• Ordered and stocked medications.

• Filed prescription

• Answered phone and tried to assist customers with questions or referred them to the pharmacist

EDUCATION

University of Cincinnati – Cincinnati, OH expected: November 2015

Bachelor of Science in Health Information Management

East Los Angeles College - Monterey Park, CA achieved: August 2013

Associate of Science in Health Information Technology

East Los Angeles College - Monterey Park, CA achieved: June 2013

Certificate of Achievement in

Health Information Coding Specialist

Licenses / Certificates

Licensed Pharmacy Technician

RHIT - Registered Health Information Technician

PROFESSIONAL SUMMARY

• Highly efficiently biller with 12 years of experience in billing Medicare part B (DME) and part D, HMOs, Medicaid, Managed Care, and other private insurances.

• Comprehensive background in CMS audits and PBM audits

• Strong analytical skills: seeks resolution for problems

• Ability to manage and coordinate multiple projects at one time.

• Team player, works well under pressure, highly-motivated

• Proficient in MS word, excel. Type 60wpm

• Bilingual: English and Filipino

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