Medical Insurance
Resume:
amy j. Rodriguez
**** ******** ****** #***-** pearland, tx 77581/C: 832-***-****/ ************@*****.***
Professional Summary
Experienced in Medical Billing/Coding - Management and Administrative with excellent communication skills demonstrated by 15 years of experience in health care.
Core Qualifications
Healthcare billing proficiency
Strong medical ethic/terminology
Problem resolution ability
Chart preparation/filing aptness
Medical coding capability
HIPAA compliance, HMO, indemnity, and commercial insurance, Eligibility determination
Statement/invoice processing
Collections review/justification
Office procedures
Patient customer service
Patient intake processing
Payment posting
Retail sales in DME (durable medical equipment)
Accounts receivables
Accounts payables
80 wpm/Windows/Microsoft word/Microsoft excel/Med flex software/MestaMed software/Futura software/Cortex software/Quick books
Experience
Office Manager 08/2011 to 11/2014
InterMed Medical Supply & Mobility Dickinson, Texas
Management of retail store for rental or purchase of specific Durable Medical Equipment.
Intake: Accurately entered procedure codes, diagnosis codes and patient information into billing software.
Insurance Verification: Efficiently performed insurance verification and pre-certification and pre-authorization functions. Acquired insurance authorizations for requested dme by the ordering physician.
Front Office Assistance: Directed patient flow during practice hours, minimizing patient wait time. Answering phones wrote clear and detailed clinical phone messages for president and staff. Cashier services,
Scheduling: Setting up appointments for dme orders requested after surgeries and procedures in conjunction with Surgical Coordinators/Case management.
Billing: Performed full-cycle medical billing in a fast-paced medical billing company. Analyzed and interpreted patient medical and surgical records to determine billable services. Corresponding with Physician offices to retrieve the necessary documentation to supply the requested DME per policy guidelines.
Claims Filing- private, commercial, workers comp, Medicare and Medicaid examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Medical Records Filing/Chart Audit: Recorded patient data carefully reviewed medical records for accuracy and completion as required by insurance companies per HIPPA compliance. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
Receivables/Collections: Appeals processing submission and re-submission of claims. Appropriately and correctly identified errors and re-filed denied/rejected claims. Carefully prepared, reviewed and submitted patient statements concerning balances due per their responsibility.
Accounts Payable: Posted charges applied payments, adjustments and denials into medical manager system. Submitted refund requests for claims paid in error.
Prosthetic Insurance Specialist 10/2009 to 03/2011
TMC Orthopedic/The Amputee Center Houston, Texas
Verified all commercial, private, Medicare and Medicaid insurance for coverage of prosthesis required.
Obtained prescriptions and clinical from various physicians for Prosthetic needs.
Obtained insurance authorizations required by certain commercial insurances per HCPC coding and ICD-9 diagnosis along with follow up in a timely manner.
Entered patient data of insurance details into patient notes for the necessary departments at six locations to be informed of the build process for their on sight patient.
Corresponding with patients to inform them of their co-insurance responsibility.
Order entry for all patient evaluations including hcpc coding for the type of prosthesis patient is to receive.
Prosthetic build quotes submitted to special funding by DARS (Department of Assistive and Rehabilitative Services).
Letter of specifications for the prosthetic build sent to the VA Hospital (Department of Veteran's Affairs) for approval.
Acted as a floater for coworkers in the same department.
Instructed purchasing department approving all parts necessary with the go ahead to order to build prosthesis.
Assisted with insurance verifications for various outsourced surgery facilities for billing pertaining to stock and bill of off the shelf orthotics.
Office Manager 11/2006 to 10/2007
OPA-Orthotic and Prosthetic Associates Houston, Texas
Managing a six office location. Interacting and guiding a max of 20 employees.
Reconciling AR and AP reports for collections follow up on a weekly basis.
Applied content through training sessions and presentations for trouble shooting and problem solving pertaining to data entry, billing/coding and collections.
Scheduled quarterly reviews for policy and procedure applications as well as following interoffice guidelines.
Transacted refunds due back to patients or insurances on a timely basis for bookkeeping.
Administered yearly employee reviews.
Managed multidisciplinary task force overseeing development in employee's.
Collaborated with various physician, clinical staff and employee staff on development, evaluation and implementation for task related issues.
Payment posting from accounts payables for monies received to be applied to multiple patient accounts from various primary, secondary or tertiary insurances along with patient co-insurance responsibilities.
Issued a daily close and prepared report for month end to check status of funds coming in and going out on a monthly basis.
Assessed patient needs related to their account information and any issues regarding to rendered service. Hippa Compliance.
Clinician Assistant 10/2000 to 11/2006
Dynamic Orthotics and Prosthetics Houston, Texas
Maintaining all billing/coding for a three office facility regarding DME, Orthotic and Prosthetic care.
Aiding and supervising staff department with their job roles.
Insurance verification for various private, commercial, Medicare and Medicaid.
Recorded and filed patient data and medical records.
Chart audit Carefully reviewed medical records for accuracy and completion as required by HIPPA compliance.
Hospital call representative for multiple hospital facility.
AR Collections thoroughly investigated past due invoices and minimized number of unpaid accounts.
AP processing posting payments to multiple accounts from patients/insurances.
Processed monthly reports for department performance.
Maintained patient privacy and confidential patient information.
Multi-tasked general office duties such as answering multiple telephone lines, completing insurance forms and mailing monthly invoice statements to patients.
Organized, updated and maintained multiple patient charts.
Maintained patient privacy and confidential patient information.
Education
High School Diploma 1994
Lamar Consolidated High Richmond, Texas
Business Administration 1994
Wharton County Jr. College Richmond, Texas
Coursework in Admin basics:
*Information processing curriculum
*Keyboarding/typing
*Document formatting/production
*Business letters, proof reading fundamentals
*Data Entry
*Office Procedures
*Word Processing
*Personal/Career applications
*Good English skills including grammar, punctuation, spelling and productive learning.
Certifications
CPR certified
Community Involvment
Greater Houston Blood Donor 2000 to Present
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