Medical biller/Compliance Officer
Resume:
Eva Alderete
N Hollywood, CA 91605
***.********@*****.***
PROFESSIONAL EXPERIENCE
[03/23/14 – 07/16/14] Pediatric Management Group, CA
Data Entry Specialist
• Primary responsible for the timely and accurate entry of charges for Radiology services
into Athena Health Collector System.
• Responsible for entering data from source documents submitted by other departments and
prepare any necessary corrections/adjustments to batch controls for balancing purposes,
and responsible for accurate and timely data entry of all charge tickets.
• Verifies demographic and financial information in the IDX system with supporting
documentation received along with the charge ticket.
• Returns documents that have invalid information to appropriate individuals for proper
completion. Reviews output for accuracy of data input.
• Balance with IDX totals and batch totals. If out of balance, review to find error and correct.
• Batches charge tickets for charge entry. Highlights any special items or circumstances for
ease of entry. Runs a batch proof tape of the procedure codes.
• When keypunching charge tickets, makes sure the medical record number matches the
name in the IDX system, keys override descriptions, prices, and FSC number when
indicated.
• Keys any authorizations, TAR number and medical remarks indicated on the charge ticket
in the appropriate fields.
• Performs other related duties as assigned by Manager.
[2008 – 09/2012] Specialty Surgical Center Beverly Hills, CA
Biller/Charge Entry Specialist
• Primary responsible for the timely and accurate entry of charges for ancillary services into
SIS billing system generated by six facilities.
• Responsible for a variety of clerical duties related to preparing, processing and reviewing
medical bills for covered expenses to private and government insurance agencies and
other third party payors.
• Review claims for completeness of information and required documents; check billing
information and other related data. Verify data entry charges to ensure quantity and
accuracy of data entered. Correct claims as necessary.
• Make adjustments or corrections on claims that were denied due to missing information or
changes in patient status; reissue bills as necessary or resubmit claims to appropriate
personnel for follow-up. Maintain effective filing system of reissued bill accounts and other
related materials of denied pending claims.
• Perform follow-up calls and written correspondence to payors on denied pending claims.
• Refer billing problems and issues with recommendations to the Manager.
• Responsible for the completeness as needed to facilitate the billing process via the SIS
Billing System and protocols.
• Research billing and charge entry issues or questions.
• Review accurate and appropriate medical necessity linkage of reported diagnosis.
• Participate in professional development activities to keep current with health care trends.
• Conduct monthly audits and post coding reviews of data entered with Manager.
• Review SIS Billing System for potential compliance issues for billing and coding.
• Review SIS Billing System for correctness of the Revenue Codes and CPT Codes for the
services listed.
[2003 – June 2008] Countrywide Bank West Hills, CA
Sr. Compliance Officer – Wholesale Lending Division
• Overseeing Federal and State Compliance monitoring and reporting within the Wholesale
Lending Division.
• Performing audit examinations by accumulating, verifying and analyzing files from the field
for compliance with State and Federal laws and Wholesale Lending policies.
• Identifying causes of and/or contributing factors relating to internal control weaknesses.
• Assisting in the development of policies and procedures to ensure Wholesale Lending
compliance with Federal and State laws.
• Developing, documenting and maintaining audit procedures required to ensure compliance
with State and Federal regulations.
[2000-2003] Countrywide Home Loans Pasadena, CA
Compliance Administrator – Full Spectrum Lending.
• Performed audits of loan files for compliance with Federal and State laws and regulations.
Assisted in the maintenance of accurate monthly HMDA data and reporting findings to the
Fair Lending Department.
• Assisted in the development of compliance related policies and tracked the progress of
Preventative Action Plans and the testing of compliance related system programming
changes.
• Created compliance bulletins for compliance topics resulting from state audit findings.
Created and wrote compliance alerts resulting in a change and/or new procedures
resulting from state audits, to ensure early notification to all divisional employees.
• Monitored and updated changes to existing forms and Compliance checklist and
maintained accurate allowable state fees table.
• Assisted compliance officers in preparing for and following-up on state audits, post-funding
audits and pre-funding audits. Monitored progress to ensure that all departments were
addressing the violations as prescribed and agreed upon in a timely manner.
[1997-2000] Countrywide Home Loans Simi Valley, CA
Mortgage Revenue Bond Team Leader – Correspondence Lending Division
• Provided focal point for questions regarding file audits, unique files, GEMS training
information and seller accommodation inquiries.
• Reviewed suspension data provided by the system to ensure the data was valid and was
communicated to the seller in a timely manner and according to division standards.
• Monitored the team pipeline to ensure that all loans are completed, validated and
communicated to the sellers. Reviewed buy-down loans to ensure the accounts are
properly collected and set up.
• Assisted in the development of training procedures and system enhancements to improve
efficiencies in the purchase and suspension process.
• Actively participated in operations meetings to assist in the communication of sellers’
issues and opportunities, as well as seller conference calls to determine lender approval
for 203K, CHFA, and Bond Programs.
• Worked with the department managers to ensure the daily work of Bond Coordinators
were complete and accurate.
[1996-1997] Countrywide Home Loans Pasadena, CA
Mortgage Revenue Bond Coordinator – Correspondence Lending Division
• Audited loan files and purchased Mortgage Revenue Bond loans.
• Responsible for tracking and maintaining daily reports. Prepared purchased packages to
be delivered to investors.
[1991-1996] Countrywide Home Loans Pasadena, CA
Loan Purchaser – Correspondence Lending Division
• Reviewed collateral and credit package loan files for accuracy.
• Notified lender of any incomplete or incorrect documentation that is needed prior to
funding.
EDUCATION
[1992] Pasadena Community College Pasadena, CA
• Attended Business courses.
[2006 - Present] Los Angeles Valley College Van Nuys, CA
• Currently pursuing an Associate Degree.
SKILLS
• Types 65-70 wpm and with excellent PC skills.
• Proficient in Lotus Notes and Windows based applications including PowerPoint, Excel
and Word.
• Working knowledge of EDGE and the AS400 system.
• SIS Billing System Software and protocols.
• Athena Billing System Software and protocols.
• Familiarity with medical terminology, CPT and ICD-9 coding.
AWARDS RECEIVED
• Employee of the Month – March 1992, July 1993, October 1994
• Employee of the Year - 1994
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