Insurance Medical Billing

SOPHIA HERNANDEZ-DURAN

***** ****** **. *******, ***** 77015

713-***-**** E-MAIL:*******@*****.***

OBJECTIVE

Detail oriented quality focused professional billing specialist with 12 years experience. Succesful track record handling complicated assignments. Highly experienced in reconciling insurance and patient payments and resolving account disputes. Strengths in streamlining processes, increasing efficiency and optimizing workflow

SKILLS

Proactive, motivated, and focused team-player attitude, self-sufficient, and prepared to go “above and beyond” on a regular basis

Developed ability to work in a fast-paced atmosphere

Ability to work on multiple projects in a timely manner and meet deadlines

High degree of accuracy and attention to detail

Strong knowledge of billing and collection practices

Knowledge of ICD-9, CPT codes and medical billing UB 92 and HCFA 1500

Fully Proficient in Excel and MS Office

eClinical Works

Emdeon

Medicare DDE

Zirmed Billing System

Availity

CUBS system

WORK EXPERIENCE

Community Health Systems- CHS July 2015 – December 2015

Responsible for all Hospice billing and follow up for 28 Agencies

Made appropriate changes for corrected bills and appealed denied claims

Enter charges for various procedure codes on claims

Analyzed EOB’s, balancing insurance and patient payments; and performed adjustments and credits

Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations

Globonics/Tyvan LLC November 2014 - April 2015

Billing Specialist

Ensures coding of claims is correct and complete

Perform appropriate follow–up with payers on non-paid and underpaid accounts

Ensures completeness of billings on a daily basis

Writes clear, concise appeals for unpaid and denied claims

Ensures payments are made according to fee schedule

Performs other tasks as assigned by the Billing Manager

Autimis Billing LLC, Houston, Texas April 2014-November 2014

Billing Team Leader

Ensured accuracy to optimize reimbursement while adhering to regulations.

Monitored tasks to improve billing practices and increase revenue.

Created Excel spreadsheets for reports daily

Ran and analyzed balancing reports daily to ensure accurate posting

Autimis Billing LLC, Houston, Texas July 2012-April 2014

Medical Billing Specialist

Edited and submited rejected claims via Zirmed for processing

Performed appropriate follow–up with payers on non-paid and underpaid accounts

Followed a 30/45/60 day insurance follow up process; appealed claim denials

Verified insurance and benefits

Handled patient inquires regarding billing and insurance

XAM Business Services July 2005-July 2012

Medicare Billing Specialist

Scrubbed, corrected and submitted claims to Medicare via Zirmed

Reviewed and corrected claims via Medicare DDE system

Handled collections on unpaid claims

Reviewed and appealed unpaid and denied claims

Performed various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers

MHMRA of Harris County December 1994-July 2005

Business Office Coordinator

Insurance verification

Collected delinquent accounts by establishing payment arrangements with patients, monitor payments and also follow-up with patients when/if payment lapses occur.

Posted patient/insurance payments

Provided front desk support to patients and quests. Patient Check in- Check out/Scheduling

Handled all patient inquires regarding billing and insurance

Typed and distributed letters and correspondence

Managed files, record systems, office supplies and inventory

Handled multi-line phone system, sort and distribute mail

EDUCATION

Autsin High School

Diploma

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