Customer Service Medical
Resume:
CELINE SALA
Email: **********@*****.***
Summary of skills:
• 25 years in Healthcare industry experience with Epic Resolute/Apex and most
Hospital Billing Systems/ Collections/ Account Follow-up. Commercial and
Government Billing.
• Professional Fee and Hospital Billing; Underpayments/High Level Appeals.
Strong background in health care insurance billing, Follow-up/high dollar
Revenue Collections, Reimbursements, Patient Registration,
Admissions/Discharge Coordinator, Patient Accommodations (bed control)
Representative and Financial Counseling. Eligibility Worker, Admissions
Discharges Transfers.
• Key strengths: ability to mufti-task, take directions, strong organizational
skills, and a high degree of professionalism. Capable and eager to learn and
implement new skills.
• Excellent customer service skills including Patient Payment plans, Large
volume patient and Insurance Inquiries, Insurance Verification/Authorizations,
processing claims (EMR), appeals, and collections.
Software: Health Connect (Epic Resolute Professional and Hospital Billing),
Apex,
IDX, CPT, ICD-9/10, MedRec, SMS, Mysis, Excel, Word, QMS Systems,
Concuity Underpayment Systems, Meditech Systems, Trimsnet
Systems,
Electronic Medical Records; State Medi-Cal/Medicare Systems. Access.
Present: Char/Morgan Law Firm – Walnut Creek
Medical Malpractice Billing Analyst- contract position
Responsible for reviewing medical services performed and charges billed for
accuracy upon settlement of medical malpractice cases.
Verify charges billed on Explanation of benefits related to Injury Claim.
Subpoena review of records against disposition subpoena.
Compile spreadsheet of medicals bills, out of pocket expenses, Physician liens.
Prepare medical billing file for settlement hearings.
April 2013- Mitts Kimura Judo Institute – San Francisco, CA
May 2014 Facility Administrator
Manage annual budget, which supports activities for martial arts
school with a faculty of 22 instructors/assistants.
Oversee billing, payroll, benefits, receivables, and purchasing activities.
Maintain member database.
Manage internet, social network, advertising and merchandise activities.
Coordinate tournament entry applications event planning travel itinerary,
August 2009- Children’s Hospital and Research Hospital - Oakland, CA
March 2013 PATIENT ACCOUNTING BILLING REPRESENTATIVE II
Responsible for primary, secondary billing, collections, reimbursement and follow
up. HMO/Private Insurance, Medicare, Medi-cal billing, third party billing. Review
claims for errors; make corrections as necessary, obtain timely authorizations.
Verify eligibility, post A/Rs and keep claim activity current. Review EOBs and
correspondence, prepare appeals denied/down-coded services incorrectly
processed for additional benefits. Send tracers on unanswered appeals and
follow up with insurance companies. Identify, follow and resolve patient billing
complaints. Process incoming (EOB) correspondence. Handle claims suspended
for additional information or correct subscriber information. Bill patient’s
responsibility statements. Contact patient’s overdue accounts. Develop
payment plans. Hi Volume Patient/Ins Inquiries. Collection agency accts. Prepare
weekly Aging and A/R reports. Perform related tasks and assignments as
necessary. Floater/Contract position.
January 2009- Kaiser Permanente/Hawaii Division - Oakland, CA
August 2009 REIMBURSEMENT BILLING SPECIALIST (CONSULTANT-SPECIAL PROJECT)
Identify/Monitor problem areas in billing procedures/coding inaccuracies and
submit recommendations for corrective measures.
Provide research which results in accurate account maintenance, billing, follow-
up, reconciliation and claims submissions.
Adjudicate charges based on coverage review; appropriate corresponding
CPT/ICD-9; and billing assignment.
Reduce amount of Hi Volume charge review session and claim edits held in
various work queues within Kaiser Permanente’s Health Connect using EPIC
Resolute/Apex Systems for Professional and Hospital Billing.
Perform special assignments/Contract Position
January 2007- Brown and Toland Medical Group - San Francisco, CA
June 2008 PATIENT ACCOUNTS BILLING REPRESENTATIVE
Responsibility for billing, reimbursements; collections, follow-up, and appeals.
Answer correspondence, review EOB’s, contractual write-offs; identify bad debts.
Self Pay Patient billing responsibility and payment plans.
October 2005- Stanford University Medical Center - Palo Alto, CA
December 2006 OUT-PATIENT REVENUE SPECIALIST – BILLING REPRESENTATIVE
DIVISION OF EMERGENCY MEDICINE
Review ER physician charge documents; CPT/ICD-9 entries for accuracy.
Reconcile billing batches in IDX billing system. Prepare for claim processing.
Experience with SMS, MedRec, Excel, Mysis, and IDX billing systems.
Contract Position.
January 2003- California Pacific Medical Center - San Francisco, CA
August 2005 BED CONTROL COORDINATOR/PATIENT ADMITTING
Tracking all admissions and discharges; in house transfers through hospital data
systems and arrange transfers to other facilities when appropriate.
Patient Admitting-Registration, insurance verification, authorizations,
admissions.
July 1998- Golden Gate OB/GYN-CPMC - San Francisco, CA
December 2002 BILLING/COLLECTIONS SUPERVISOR
Responsible for all Professional Fee billing functions. Government and
Commercial billing.
Customer Service; payment posting; reviewing EOBS, follow-up;
reimbursements;
Accounts receivables/Payables, collections, benefit authorizations; daily postings,
reconcile/adjudicate claims; bank records, claim appeals, patient payment plans.
Assumed key role in selection, hiring, training, and supervision of staff in Billing
Dept.
January 1990- San Francisco General Hospital ER Admitting /Eligibility (Provisional)
July 1998 ER REGISTRATION/HOSPITAL ADMISSIONS REPRESENTATIVE
Responsible for all eligibility inquiries to determine appropriate programs or fee
schedule
Assigned to patients. Referral to government programs if eligibility determined.
Compile accurate demographic insurance and billing information of patients.
Obtain authorizations and signatures required for treatment and admission.
Contact this candidate