Medical Billing/Collection Specialist

Elizabeth Cisneros

***** ******* **. ****: 714-***-****

Garden Grove, CA. 92843 e-mail: *************@*****.***

Summary

Driven Medical Billing/Collection Professional with proficient skills in all aspects of medical billing and collections. Proven ability to meet deadlines in high-pressure environments with attention to detail.

Professional Highlights

Bilingual (Spanish)

Excellent typing skills

Well organized and detail oriented

Medical Collections

Medical Billing

Insurance Verifier

Ability to handle multiple tasks and prioritize their importance

Ability to work under stress and time

Able to work independent as well as with other co-workers and staff

Claim entry

Research analysis

Medical provider networks

Excellent phone skills and customer service

Accounts receivables

HIPPA Compliance

ICD9/10/CPT

CMS-1500 Claim forms

Professional Experience

Mesa Medical Group, August 08, 2011-present

Workers Compensation

Collections Specialist Supervisor

Supervise and lead the Collection Department, along with the Hearing Representatives

Medical Provider Network Coordinator

Training all incoming extern students and new employees in the collection department

Serve as the Claims Examiners, Defense Counsel, Applicant Counsel, Physicians and Third Party Administrators contact for all billing/collections activities, questions, needs and responding to inquires

Responsible for monitoring and maintain assigned accounts- collection calls, account adjustments, small balance write off, account settlements, settlement demands, responding to correspondence from insurance carrier, third party administrators to facilitate payment, follow up on unpaid claims

Performing other assigned tasks and duties necessary to support the Accounts Receivable Department- inputting mail correspondence and uploading document to patient electronic record, filing Liens, preparing DORs and other documents necessary to ensure payment

Authorizing settlements offers from Hearing representatives at the WCAB

Tracking cases to negotiate and settle prior to the Lien Conference and/or Lien Trial to minimize litigation

Submitting medical records request, completion of additional information requests, etc. as requested by Insurance carriers, Defense Counsel, Applicant Counsel, Third Party Administrators and Physicians

Reading and interpreting insurance Explanation of Benefits, Explanation of Reviews

Self-educate within your specialty regarding new rules, new codes and changes to workers compensation regulations and/or labor codes.

Data entry of patient demographics and insurance information

Processing claims, paper CMS-1500 with report and request for authorization, corrected billings, appeals and second review request. When appropriate to obtain maximum reimbursement

Innovative Medical Management, February 2010 – August 2010

Medical Biller and Verifier

Verified workers comp. Insurance, input patient information in Medisoft

Created encounter printed and mailed out HCFA forms.

Noted and updated mail correspondence, which includes; EOB’s, EOR’s, attorney and insurance letters.

Kentucky Fried Chicken, August 2008 – January 2010

Team Member

Prepare/store/pack food items/serve/deliver company products according to company policy and procedures, and in an efficient, friendly and courteous manner.

Handled customer complaints on the spot and making sure that all there questions or concerns were taking care of.

Rotated food products on oldest date first basis and keeps product stocked as required.

Adhered to all Cash Accountability standards and procedures. Operates the cash register following correct cash handling and security procedures.

Taking orders from the customer in a courteous, friendly and efficient manner. Knowing about new products and promotions and serves customers with a sense of urgency.

Education

Newbridge College, February 2011 – July 2011

Certificate in Medical Billing and Coding

Santiago High School, September 2004 – June 2008

High School Diploma

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