Insurance Medical

MICKELD VEGA

Phn: 713-***-****

Email: ******@*****.***

Houston, Texas

CAREER OBJECTIVE

Medical Office Specialist; detail oriented and quality focused, professionally trained in all aspects medical administrative support including, but not limited to Utilization Management, Provider Services, Patient Financial Services, Claims, Collections and Medical Billing

KEY ADMINISTRATIVE SKILLS

Medical Terminology

Payment Posting

Member Services

Insurance Verification

Auth's & Referrals

Medical Billing &

Collections

Medicare/Medi-Cal/

Medicaid

ICD-9 AND CPT-4

Coding/HIPAA

HCFA 1500

UB04/UB92

Data Entry

Alpha/ Numeric Indexing

Appeal Letters

Patient Customer Service

Call Center

DOFR

Provider Contracting

PPO / HMO / IPA / Medical

Groups

Accounts Receivable/ Payable

Availity

IDX 4.0

Medi-Soft

Medical Manager

Centricity

Outlook 2013, MS Word/Excel

2010

Emdeon

EPIC

Advantex

Touch Works

All Scripts

EPIC

CUBS

PROFESSIONAL EXPERIENCE

SPRING MEDICAL ASSOCIATES 12/2015

PRESENT

Front Office Coordinator

Responsible for the direction and supervision of front office team members, responsible for the registration of new patients and verifying eligibility, collecting copays, coinsurance and deductibles, re sponsible for the timely and accurate posting of payments, denials and adjustments. A ccurate and detailed posting of EOB payment from the insurance companies to patient accounts. P repare and submit appeal for various denial (ie. Under payment, untimely filing, retro authorization request, Process all non-payment EOB’s and send letters to patients regarding deductibles, non-covered services, etc. Assist with answering telephone calls. UNITED SURGICAL PARTNER (USPI) (Temp) 03/2015 –

12/2015

Medical Insurance Collector- Payment Poster

Responsible for the direction and supervision of 6 team members, re sponsible for the timely and accurate posting of payments, denials and adjustments. A ccurate and detailed posting of EOB payment from the insurance companies to patient accounts. Verify checks against totals on summary transmittals, P osting Insurance and patient payments both manually and electronically. R econciles electronic lockbox transactions, electronic remittances (ERA) and EFT payments . Prepare and submit appeal for various denial (ie. Under payment, untimely filing, retro authorization request, Process all non-payment EOB’s and send letters to patients regarding deductibles, non-covered services, etc. Assist with answering telephone calls. Balance facility deposit log daily Prepare refunds to insurance companies and patients as well as note contractual over payments in the PAS. P erforms other job related duties as assigned. ECARDIO DIAGNOSTICS 03/2014 –

02/2015

Medical Reimbursement Specialist/Payment Poster

Responsible for the direction and supervision of 10 team members, Responsible for billing, collecting, post payment review, credit balances and correspondence functions of all aged government, non-government and patient accounts, Prepare and submit appeal for various denials (i.e. under payment, untimely filing, and retro authorization request, investigational and not medically necessary.), Review outpatient claims on HCFA 1500 to commercial and private insurance, Medicare, Medi-Cal and various Managed Care medical plans such as HMO, POS, EPO, and Medicare Advantage Plans. Also PPO plans. Extensive Knowledge of contractual agreements. Maintains ongoing knowledge of all standard bill forms and other mandatory state billing forms and filing requirements. Re-file claims to insurance companies as needed for collections. Assist with answering telephone calls. Any other projects or duties as needed. Follow-up of aging Accounts Receivable insurance claims.

OFFICE WORKS TEMP (TRI CITY REGIONAL MEDICAL CENTER) 09/2013 – 03/2014

Reimbursement Specialist (Central Business Office) Responsible for Medical Insurance billing and Collections bot physician (HCFA 1500) and facility (UB04) claims, Work with patients to collect outstanding balances, ICD9 and CPT coding, Process payments and adjustments per contracted rate. Assist patients with disputes and complaints pertaining to hospital claims and physician charges, Process and review insurance and patient correspondence, Bill Physician HCFA (1500) and Hospital (UB92 & 04) charges to commercial and private insurance, Medicare and Medicaid. Appeal denied and under paid medical claims to ensure proper and correct payments.

RANDSTAD WORKS TEMP (UCLA FACULTY PRACTICE GROUP) 04/2013- 08/2013

Patient Biller- Collector III

Communicate with patients regarding outstanding balances and timely pay-off account, establish individual payment plans based on pre-established collection procedures, respond to correspondence, and heavy telephone contact to ensure timely follow-up and account resolution, Bill insurance carriers for appropriate payments to ensure maximum collections. Created and Submitted Appeal Letters adjust or corrections on claims that were denied due to missing information. Conduct follow-up with insurance companies on denied or rejected claims, Ability to effectively communicate with insurance companies and patients to facilitate timely payment of accounts adjustments to accounts including referral to collections, write-offs, and insurance adjustments, Review assigned inpatient and outpatient claims on Physician HCFA

(1500) charges and Facility UB92 & 04 to commercial and private insurance, Medicare, Medi-Cal and various Managed Care HMO plans to include IPA’s and medical groups. CYMETRIX - Temp (Gardena, CA) 09/2012 –

4/2013

Medical Collections Rep. (Cedars Sinai)

Extensive insurance follow- up of Inpatient, Outpatient, Radiology, Ob-gyn maternity, IV Infusion, Radiation Oncology, ER and Diagnostic claims on UB04 from a variety of insurances. Medicare, Medi-Cal and various Managed Care HMO plans to include IPA’s and medical groups, Reviewed EOB's and RA for proper Contractual facility claims of High Dollar Claims, Tracking/ analyzing insurance payments vs. contractual agreements (Stop Loss, 24-hour rule, Per Diem, Percentage rate and Fee Schedule.). Apply contracted adjustments to ensure the correct balance on the account is reflected, follow up and outstanding past due insurance claims to ensure correct payment is received, Bill corrected claims to the appropriate insurance carrier for appropriate payments to maximum collections, Prepare and submit appeal for various denials (i.e. under payment, untimely filing, retro authorization request), Updates patient accounts with corrected demographic or insurance information. Monitors all denials for trends and issues and reports finding to supervisor, Bills or re-bills as necessary, Facility Claims billed on UB-04 Thru the EPIC Medical Software, assist patients with disputes and complaints pertaining to hospital claims, Process assigned monthly reconciliation report related to data integrity projects ST. JUDE HERITAGE –Fullerton,CA - Temp 3/2011 to

8/2012

Medical Billing/Collector

Assist patients with questions regarding their outstanding balances, payment arrangements and financial assistance applications, Answer patient and insurance calls regarding claims in a high volume call center, Process payments and adjustments according to contracted rates from Medical, Medicare, and commercial insurances, Process and review both insurance and patient correspondence and payments Review and audit patient charges for accuracy and pulling primary EOB’s for secondary claims, Verify Insurance payments and assist patients with; contracted providers, specialist, ancillary and non-contracted providers; health plans; billing and collection companies Billed Physician HCFA (1500) charges and Facility UB92 & 04 to commercial and private insurance, Medicare, Medi-Cal and various Managed Care HMO plans to include IPA’s and medical groups, Assist with the preparation of accounts for third-party collection placement EYE PYHSICIANS OF LONG BEACH SURGERY CENTER – Long Beach, CA 2/2009 to 2/2011

Medical Office Specialist/Billing & Collections

Responsible for the direction and supervision of 12 team members, Insurance Authorization/Collecting cash & deposits for surgery center, Obtains and verifies patient demographic data for each encounter, Extensive Knowledge of Facility/Professional contractual agreements with insurance companies to obtain authorization for services, Patient Registration for appointed outpatient surgeries/Admission- Check-In, Schedules and confirms new or follow up appointments for patients, Schedules ancillary appointments, diagnostic tests and follow up appointments per provider orders/requisitions, Alerts clinic staff and providers of any changes or discrepancies in patient’s scheduled appointment, Processes patient payments, Enters, batches and reconciles surgery center payments daily, Prepares the deposit and delivers to the appropriate location per department guidelines, Coordinates referrals, Prepare and submit appeal for various denials (i.e. under payment, untimely filing, and retro authorization request, investigational and not medically necessary.) Review outpatient claims on HCFA 1500 to commercial and private insurance, Medicare, Medi-Cal and various Managed Care medical plans such as HMO, POS, EPO, and Medicare Advantage Plans. Also PPO plans. Responsible for billing, collecting, post payment review, credit balances and correspondence functions of all aged government, non-government and patient accounts

CHMB MEDICAL SOLUTIONS – Escondido, CA 09/2007 to

2/2009

Medical Account Specialist

Responsible medical billing, Work with patients to collect outstanding balances, Bill Hospital and Physician charges to commercial, private insurance, Medicare and Medicaid, Ambulatory Surgical Center Billing Process payments and adjustments according to contracted rate. Assist patients with disputes and complaints pertaining to hospital claims, Process and review insurance and patient correspondence Answer patient and insurance calls regarding claims Review and audit patient charges to satisfaction Work with the MSI Division of Health Care Agency Work with the California HealthCare for Indigents Program and with the EmergencyMedical Service Fund, Bill Physician HCFA (1500) charges to commercial and private insurance, Medicare and Medi-cal, Prepare accounts for third-party collection agency INTERMED HEALTHCARE ASSOCIATES – Houston, TX 06/2003 to 8/2007

Medical Biller and Collector

Worked with patients to collect outstanding balances, Processed ICD9 and CPT coding, Processed Medicare Charges, adjustments and payment posting, Processed Ambulatory Surgical Center Billing, Billed Hospital and Physician Charges to commercial, private insurance, Medicare and Medicaid, Collected for various commercial, government and private insurance claims. Created appeals for insurance claims using Senate Bill 418 and House bill 610 to insure proper processing and payment, appealed “Silent PPO of 3 rd party administers

RENAISSANCE HEALTHCARE SYSTEMS INC. – Houston, TX (business closed) 2/1995 to 5/2003

Reimbursement Specialist (Central Business Office) Responsible for the entering of charges for both physician and facility for medical insurance billing, Worked with patients to collect outstanding balances, Preformed ICD9 and CPT coding, Processed and posted payments and adjustments according to contracted insurance rates, Assisted patients with disputes and complaints pertaining to hospital, physician and ASC charges, Processed and reviewed insurance and patient correspondence, Billed Physician (HCFA 1500) and Hospital (UB04) charges to commercial, private insurance and Medicare and Medicaid LICENSES & CERTIFICATES

Certificate of Business Office Certificate of Data Entry Certificate of Word EDUCATION AND TRAINING

06/86 H.I.S.D. GED Houston, Texas

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