Mario A. M. Hermosa

**** *. **** ******

Phoenix, AZ 85018

Cell: 602-***-****

ad0v4x@r.postjobfree.com

Objective: To successfully accomplish the task necessary to achieve the goals, proficiently and effectively, individually or as a team player in order to satisfy the customer’s needs.

Qualification: Thirty years in the healthcare insurance industry in the areas of claims examining, customer service, and account follow-up. Worked in full-cycle medical billing for over 10 years. Speak Spanish fluently and have assisted the Hispanic community in problem areas of debt. I have extended knowledgeable of the ICD-10-CM, HCPC’s, and CPT coding and guidelines.

Education: Associates in Business (Accounting), Chaparral College, Tucson, AZ., 12/20/91

Relevant Experience:

11/01/2019 – Present – Trubridge – Mobile, AL – Service Specialist II

Work from home position for medical billing and follow up for various insurances.

Perform full-cycle medical billing from claim generation to insurance payment with assurance that all adjustments are correct prior to submitting any remaining balance as patient responsibility.

Systems used are Thrive and Rycan.

10/01/2009- 10/31/2019 – Maricopa Integrated Health System, Phoenix, AZ; Medicare Revenue Specialist

Review of CPT and ICD-10 coding correct prior to billing Medicare. Contact respective clinics or coders regarding discrepancies in coding for correction.

Submit hospital claims for in-patient (acute and critical care), out-patient, behavioral health, and dialysis services.

Corrected information regarding RTP claims prior to resubmitting back to Medicare.

Adjust patient account for correct patient per Medicare explanation of benefits (EOB).

Use of EPIC system and X-claim through Medical Manager.

Assisted with professional billing regarding Medicare claims.

Contact patient’s regarding coordination of benefits and MVA accident information and/or any other secondary insurance.

Periodically reviewed CMS guidelines through Noridian to ensure that correct billing is maintained. Attended CMS webinars as necessary.

Submit appeals regarding denied claims to justify medical necessity, both electronically and through regular mail.

1/1/2008 - 6/2009 – Southwest Medical Billing Services, Phoenix, AZ; Medical Collection Specialist

Worked with various insurance products such as HMO, PPO, Indemnity, Senior, Senior Advantage, Indian Health, and Arizona Medicaid (AHCCCS).

Appealed denied claims with insurances companies justifying services rendered.

Educated patients with their insurance for better understanding of their benefits.

10/06- 07/07: Southwest Preferred Dental Organization, Phoenix, AZ; Account Service Representative

Assisted members in better understanding their insurance plan for maximum benefit utilization.

Have spoken at enrollment meetings explaining dental benefits available to employee groups both English and Spanish

Submitted group renewals to contracted brokers and agents.

Assisted brokers and agents with employee dental benefit packets per their requests.

7/00-10/06: Arizona Oncology Associates, Tucson, AZ; Account Follow-up Specialist II.

Use of IDX and Winterm software for billing and collections.

Followed up with various insurance, both commercial and government regarding claims submitted.

Submitted appeals for chemo-therapy drugs or growth factors (i.e. Procrit, Aranesp) with documentation to substantiate usage.

Corrected adjustments on accounts per explanation of benefits to ensure correct patient balance prior to moving to self-pay.

Performed audits on patient accounts for correct insurance payment and adjustment prior to submitting statements regarding patients’ responsibility.

Assisted with patients who are financially challenged by seeking programs which aid them in payment of their portion after insurance payment of their account through various healthcare or pharmaceutical companies which have patient assistant programs.

Customer service oriented, always trying to find a solution to a customer’s problem in hopes of achieving resolution for their satisfaction.

1/00-6/00: Maryvale Hospital Medical Center, Phoenix, AZ; Account Representative

Followed up with commercial insurances regarding claim submitted ensuring receipt of and payment of claim.

Called patients for payment arrangements after insurance payment.

Communicated with attorneys regarding motor vehicle related claims.

1/99-1/00: Healthcare Financial Staffing, Phoenix, AZ; Collections, customer service representative, medical billing.

Received calls from patients regarding incorrect balances after medical insurance payment.

Communicated with cash posting department requesting adjustment of patient balance per explanation of benefit.

12/97-12/98: Medpro, Phoenix, AZ; Insurance Follow-up Specialist (Medicare).

Billing of Medicare professional charges

Appealed rejected claims to Medicare with necessary physicians’ notes to justify service.

9/97-12/97: Payco General American Credit, Phoenix, AZ; Account Representative (Collections).

Called patients to make payment arrangements after insurance payment.

Submitted collection letters to patients’ home address.

12/96-8/97: EAI Medical Staffing, Tucson, AZ; Medical collections.

7/95-10/95: Kelly Temporary Services, Tucson, AZ; Insurance Referral Clerk.

1/95-6-95: University Physicians, In., Tucson, AZ; Insurance Follow-up Representative.

Called various insurance companies for status of claims submitted and noted patients’ accounts.

Verified correct contractual adjustments according to insurances’ explanation of benefit.

Called patients to arrange payments for balance left over.

11/92-12/94: Intergroup of Arizona, Tucson, AZ; Medical Claims Examiner, Member Service (AHCCCS Select), Customer Service Representative.

Process of outpatient medical claims for Third Party Administration (TPA) and Health Maintenance Organization (HMO).

Reviewed for authorization if applicable.

Ensured CPT and ICD-9 coding correct prior to adjudication of claim for payment.

On the phones as customer service representative assisting customers with incorrect claims payments by reprocessing claim “on the spot” to ensure customers’ satisfaction.

1/92-11/92: Northwestern National Life Insurance, Tucson, AZ; Medical Claims Examiner.

Training received regarding Current Procedural Terminology (CPT), Healthcare Common Procedure Coding (HCPC), and International Classification of Diseases, Ninth Revision (ICD-9).

Training in use of CPT and ICD-9 coding on claims form for proper reimbursement to provider.

Contact this candidate