Nora Montes

Senior Medical Collector - Ronald Reagan UCLA Medical Center

North Hollywood, CA 91605

ad0x62@r.postjobfree.com

+1-818-***-****

To enhance my career path by obtaining a position as a Sr. Medical Collector with a dynamic organization that will allow for me to contribute and advance. Work Experience

Medical Claims Insurance Refund Specialist

Henry Mayo Newhall Hospital - Santa Clarita, CA

April 2016 to Present

Santa Clarita, CA

• Responsible for working with insurance companies and medical billing staff to manage the billing reimbursement process to ensure hospitals are paid appropriately.

• Identify methods of payment for insurance.

• Managing financial and medical records.

• Review records, coding and billing practices to ensure compliance.

• Preparation and review of insurance claims.

• Submit insurance corrected claims to insurance carriers.

• Follow-up on unpaid claims or appeals.

• Audit invoices for insurance companies.

• Verify insurance contracts for proper medical claim payments and adjustments. Senior Medical Collector

Ronald Reagan UCLA Medical Center - Los Angeles, CA January 2013 to Present

Los Angeles, CA

• Extensive collections experience with emphasis on Recurring Managed Care, PPO &HMO

• Wide knowledge of ICD-9 and CPT-4 coding

• Prepare work aged account receivables report.

• Responsible for reviewing, correcting, submitting claims on a UB and 1500 forms to various insurance companies.

• Knowledge with CPT/HCPCS/ICD-9 codes.

• Knowledge of collection techniques and collection laws along with good communication skills.

• Extensive knowledge of commercial and contract payer processing guidelines and timeframes.

• RA's, ERA's, EOBs identify opportunities for rebilling of claims by research and determining the cause of denial in order to ensure payment of claim.

• Complete RTD, CIF, Tracers, and Disputes/Appeals as appropriate following payer's filing timelines and regulations.

• Maintain a workflow of 35-38 accounts to handle to conclusion daily

• Tools: STOCKAMP, MAINFRAME, CONTRACT MANAGEMENT, PATHWAYS, EPIC Medical Collector

Tower Hematology Oncology Med Group

February 2012 to November 2012

Encino, CA

• Extensive collection experience with strong analytical skills, appeals/underpayment collection activities.

• PPO, Medicare Commercial, and Private insurance.

• Knowledge of collection techniques and collection laws, responding to correspondence, process insurance refund.

• Monitored all delinquent accounts and managed collection activities.

• Establish and maintain online resources used in handling claims

• Tools: Mainframe

Medical Collector

Surgery Center of the Pacific

November 2007 to December 2011

Santa Monica, CA

• Extensive phone contact with patients, third party payers and government payers,

• Preparation of billing, Implant/hardware Invoices, agency assignment, fee negotiation agreement, denial, rejections and appeals.

• Work NextGen (NG) tasking as assigned ensuring timely follow up is performed

• Conduct lab audits for missing or added labs to ensure Surgery Centers have retracted charges appropriately in NG in a timely manner. Update and make changes in NG as appropriate when assigned.

• Responsible for the daily downloading of claims from Next Gen files to DSG uploading in a timely and accurate manner. This process covers primary and secondary payers.

• Utilize NG and DSG to full capacity in order to perform transactions and being able to reconcile all encounters.

• Extensive knowledge of Workers Compensation, PPO, HMO, Medicare and Private insurance.

• Tools: SMS

Medical Collector

HRG/ Kaiser-Motion Picture Hospital

March 2001 to December 2001

Pasadena, CA

• Preparation of billing, Insurance follow-up HMO, PPO, Commercial and Private Insurance,

• Extensive phone contact with patients.

• Knowledge of Medicare eomb., insurance EOB and CMS denial

• ADVANTEX

• MEDITECH

Medical Collector

Catholic Healthcare West - Los Angeles, CA

March 1991 to December 2001

Los Angeles, CA

• Extensive phone contact with patients, third party payers and government payers, in order to facilitate collection of 1,000 to 1,200 accounts for 15 hospitals and medical groups.

• Ensuring that all appeals processes are followed when insurance sources do not pay properly

• Preparation of billing, agency assignment and legal assessment, fee negotiation agreement, Workers Compensation, HMO, PPO and Private Insurance.

• MAINFRAME

Office Manager/Medical Assistant

Los Angeles Multi-Specialty Medical Center - Los Angeles, CA February 1980 to March 1991

980

Santa Monica, CA

• Front and back office, EKG

• Venipuncture assist with all medical procedures, schedule appointment, prepare

• Correspondence, handle phone calls, complete all insurance forms

• Inquire medical histories, injections, surgical set-up Pap-Smear, GC Culture, Sigmoidoscopy, preparing medications.

Education

Information Science

System Programming Development Institute - Los Angeles, CA 1986 to 1988

Additional Information

SKILLS:

• MS Office 2003-2007 (Word, Power Point, Excel, Outlook, Publisher)

• Windows XP & Mac OS X

• Expert with State, Federal, and HIPPA laws & guidelines

• Pathways

• Stockamp

• Mainframe

• EPIC

• Adavntex

• Meditech

• Excel Care Connect/Epix

• Medicare & Medicaid

• Government and non-Government payer sources

• Bookkeeping and Collection Procedures

• 10 Key

• Fluent in Spanish and English

Contact this candidate