Billing Specialist Family Support
Resume:
MARITES S. MIRANDA
Staten Island, NY 10310
Cellphone #: 1-929-***-****
Email Address: ad10vj@r.postjobfree.com
OBJECTIVE: To obtain a position where y knowledge, education, and skills will grow and provide an
opportunity for further advancement in the field of Accounting.
EXPERIENCE:
04/19/23 – 01/12/24 Permanent Position - Center for Family Support
Medicaid & Contract Billing Specialist/Finance Department
Using EVERO System/Sage System/Therap Billing System/FloQast System – Billing both for New York & New Jersey Location with Self Directed Support for all 10 Programs – These are the following Programs:
1.SDS-Support Brokerage
2.Start-Up Broker
3.SDS-Self-Hired Community Habilitation
4.Fiscal Intermediary
5.SDS-Self-Hired Respite
6.SDS-Housing Subsidy
7.SDS-Family Reimbursed Respite
8.SDS-Individual Directed Goods & Services
9.SDS-Live-In Caregiver
10.SDS-Other Than Personal Service Items.
EVERO System Usage: NY Billing
Make sure All Batches Pending Claims for all 10 Programs has been billed directly to Medicaid electronically
Make sure All Claims for all 10 Programs have been submitted weekly with Minimum Total Amount of $100K
Make sure All Denied Claims for all 10 Programs has been forwarded to the correct Department to assure timely filing for corrected claim submission and appeal submission has been met.
Make sure All Adjusted Claim has been adjusted correctly from the original claim and submitted correctly thru Payer on timely filing.
Make sure All Denied Claims for all 10 Programs has been resubmitted on timely filing.
Make sure All Transmission Report for all 10 Programs has been downloaded and saved to Share Folder for General Ledger Report purposes.
Make sure All Remittance has been downloaded and saved to Share Folder for Payment Postings purposes.
Make sure All Expenses for all 10 Programs has been reported to EVERO and downloaded the Report from EVERO and added to MasterList of Expenses Excel Report.
Make sure All Expenses Matches with Billings to all 10 Programs to assure All has been billed correctly to avoid loses.
SAGE System Usage: NY Billing & NJ Billing
Make sure All Batches of Claims for all 10 Programs that has been submitted thru EVERO weekly has been saved to Sage System.
Make sure All Batches of Claims for all 10 Programs has received electronically by the Payer successfully. Once it is received Payer’s report will be provided and that claim report would provide the batches number that is used to report as invoices to our Sage System for Revenue in our General Ledger.
Make sure All Batches of Claims for all 10 Programs has been prepared for the invoices number per individual claims per programs and that will be use to convert into CSV.
Make sure All Batches of Claims for Adjustments for all 10 Programs has been adjusted correctly before converting them thru CSV files in order to import to Sage that will make adjustments to the current charge of the claim to record the correct Revenue Amount after Adjustment has been made.
Make sure All Batches of Claims for all 10 Programs has been converted to CSV files in order to import to Sage.
Make sure All CSV files ready to import to Sage has been uploaded to Sage successfully.
Make sure you received notification indicating that the import has been successful.
Make sure all Billing Batches for all 10 Programs that has been billed thru EVERO and Transmitted Successfully has been tied with Sage General Ledger Report for our Revenue to assure all has been recorded correctly and accurately.
Make sure all Expenses Reported to EVERO has been imported to Sage by the Proper Department that do the Reporting.
Make sure all Expenses has been run and downloaded to CSV and do VLOOKUP with EVERO MasterList Expenses Excel Report to prepare Report to be recorded to FloQast.
Make sure All Expenses Matches with Billings to all 10 Programs to assure All has been billed correctly to avoid loses.
Make sure All Expenses has been billed and recorded to Sage correctly to assure all has been reported as Expenses to balance with Revenue AR.
Make sure all Aging Report has been downloaded to CSV and review all pending claims that has been 120+ days and over for claim status to verify if the claim has been paid/denied/reprocess/or must be adjusted based on claim status provided by the Payer Remittance.
Make sure All NJ Billing weekly has been recorded and downloaded from Therap Billing System transfer to Excel and recorded to Sage & FloQast.
Make sure every end of the Month both Sage & FloQast has been balanced based on Expenses & Billing Report from EVERO
Make sure All Excel Report has been saved into BOX & Shared Folder properly in a monthly basis based on Billing Programs both for NY & NJ Locations.
Make sure All are approved by Supervisor & Signed up to close the monthly report.
FloQast System Usage: NY Billing & NJ Billing
Make sure All Batches of Claims for all 10 Programs that has been submitted thru EVERO weekly which has been saved to Sage System weekly is now uploaded and saved thru FloQast System to maintain the Financial Report for the Company.
Make sure All Batches of Claims for all 10 Program that has been created for transmission has been recorded to FloQast correctly to tie balance with Sage & FloQast of what is transmitted from EVERO.
Make sure All Batches of Claims for all 10 Programs that has been Adjusted has been saved properly to avoid duplication of the claims report for Revenue thru Sage & FloQast.
Make sure All Expenses Report from EVERO MasterList Expenses Excel Report has been matched VLOOKUP from Sage and those Matches information that come from EVERO MasterList Expenses Excel Report must be transferred to FloQast.
Make sure All Expenses Matches with Billings to all 10 Programs to assure All has been billed correctly to avoid loses.
Make sure all Expenses has ties with Sage & FloQast to assure all are recorded accordingly.
Make sure All NJ Billing weekly has been recorded and downloaded from Therap Billing System transfer to Excel and recorded to Sage & FloQast.
Make sure every end of the Month both Sage & FloQast has been balanced based on Expenses & Billing Report from EVERO
Make sure All Excel Report has been saved into BOX & Shared Folder properly in a monthly basis based on Billing Programs both for NY & NJ Locations.
Make sure All are approved by Supervisor & Signed up to close the monthly report.
12/29/22 - 04/18/23 Temporary Position Possible to Hire - Robert Half International Inc. Contract with Center
for Family Support
Medicaid & Contract Billing Specialist/Finance Department
Using EVERO System/Sage System/Therap Billing System/FloQast System – Billing both for New York & New Jersey Location with Self Directed Support for all 10 Programs – These are the following Programs:
11.SDS-Support Brokerage
12.Start-Up Broker
13.SDS-Self-Hired Community Habilitation
14.Fiscal Intermediary
15.SDS-Self-Hired Respite
16.SDS-Housing Subsidy
17.SDS-Family Reimbursed Respite
18.SDS-Individual Directed Goods & Services
19.SDS-Live-In Caregiver
20.SDS-Other Than Personal Service Items.
EVERO System Usage: NY Billing
Make sure All Batches Pending Claims for all 10 Programs has been billed directly to Medicaid electronically
Make sure All Claims for all 10 Programs have been submitted weekly with Minimum Total Amount of $100K
Make sure All Denied Claims for all 10 Programs has been forwarded to the correct Department to assure timely filing for corrected claim submission and appeal submission has been met.
Make sure All Adjusted Claim has been adjusted correctly from the original claim and submitted correctly thru Payer on timely filing.
Make sure All Denied Claims for all 10 Programs has been resubmitted on timely filing.
Make sure All Transmission Report for all 10 Programs has been downloaded and saved to Share Folder for General Ledger Report purposes.
Make sure All Remittance has been downloaded and saved to Share Folder for Payment Postings purposes.
Make sure All Expenses for all 10 Programs has been reported to EVERO and downloaded the Report from EVERO and added to MasterList of Expenses Excel Report.
Make sure All Expenses Matches with Billings to all 10 Programs to assure All has been billed correctly to avoid loses.
SAGE System Usage: NY Billing & NJ Billing
Make sure All Batches of Claims for all 10 Programs that has been submitted thru EVERO weekly has been saved to Sage System.
Make sure All Batches of Claims for all 10 Programs has received electronically by the Payer successfully. Once it is received Payer’s report will be provided and that claim report would provide the batches number that is used to report as invoices to our Sage System for Revenue in our General Ledger.
Make sure All Batches of Claims for all 10 Programs has been prepared for the invoices number per individual claims per programs and that will be use to convert into CSV.
Make sure All Batches of Claims for Adjustments for all 10 Programs has been adjusted correctly before converting them thru CSV files in order to import to Sage that will make adjustments to the current charge of the claim to record the correct Revenue Amount after Adjustment has been made.
Make sure All Batches of Claims for all 10 Programs has been converted to CSV files in order to import to Sage.
Make sure All CSV files ready to import to Sage has been uploaded to Sage successfully.
Make sure you received notification indicating that the import has been successful.
Make sure all Billing Batches for all 10 Programs that has been billed thru EVERO and Transmitted Successfully has been tied with Sage General Ledger Report for our Revenue to assure all has been recorded correctly and accurately.
Make sure all Expenses Reported to EVERO has been imported to Sage by the Proper Department that do the Reporting.
Make sure all Expenses has been run and downloaded to CSV and do Vlookup with EVERO MasterList Expenses Excel Report to prepare Report to be recorded to FloQast.
Make sure All Expenses Matches with Billings to all 10 Programs to assure All has been billed correctly to avoid loses.
Make sure All Expenses has been billed and recorded to Sage correctly to assure all has been reported as Expenses to balance with Revenue AR.
Make sure all Aging Report has been downloaded to CSV and review all pending claims that has been 120+ days and over for claim status to verify if the claim has been paid/denied/reprocess/or must be adjusted based on claim status provided by the Payer Remittance.
Make sure All NJ Billing weekly has been recorded and downloaded from Therap Billing System transfer to Excel and recorded to Sage & FloQast.
Make sure every end of the Month both Sage & FloQast has been balanced based on Expenses & Billing Report from EVERO
Make sure All Excel Report has been saved into BOX & Shared Folder properly in a monthly basis based on Billing Programs both for NY & NJ Locations.
Make sure All are approved by Supervisor & Signed up to close the monthly report.
FloQast System Usage: NY Billing & NJ Billing
Make sure All Batches of Claims for all 10 Programs that has been submitted thru EVERO weekly which has been saved to Sage System weekly is now uploaded and saved thru FloQast System to maintain the Financial Report for the Company.
Make sure All Batches of Claims for all 10 Program that has been created for transmission has been recorded to FloQast correctly to tie balance with Sage & FloQast of what is transmitted from EVERO.
Make sure All Batches of Claims for all 10 Programs that has been Adjusted has been saved properly to avoid duplication of the claims report for Revenue thru Sage & FloQast.
Make sure All Expenses Report from EVERO MasterList Expenses Excel Report has been matched VLOOKUP from Sage and those Matches information that come from EVERO MasterList Expenses Excel Report must be transferred to FloQast.
Make sure All Expenses Matches with Billings to all 10 Programs to assure All has been billed correctly to avoid loses.
Make sure all Expenses has ties with Sage & FloQast to assure all are recorded accordingly.
Make sure All NJ Billing weekly has been recorded and downloaded from Therap Billing System transfer to Excel and recorded to Sage & FloQast.
Make sure every end of the Month both Sage & FloQast has been balanced based on Expenses & Billing Report from EVERO
Make sure All Excel Report has been saved into BOX & Shared Folder properly in a monthly basis based on Billing Programs both for NY & NJ Locations.
Make sure All are approved by Supervisor & Signed up to close the monthly report.
12/21 – 10/22 Admin/Clerical – Data Entry II Richfield, Minnesota SWAT Team Work
Review all Patients Expiration of Authorization per Insurance Payer and Request all Authorizations per Patient Expired Authorization for the CPT Code S5161.
Check all Patients Eligibility and update the RPM System & Excel Report.
Once Authorization has been approved collect all detailed approved Authorization and Report them thru Excel.
Review all Explanation of Benefits from all Insurance Companies final payments and/or denials of payments posted and verify if the denial reason is correct.
Review balances for claims unpaid by Insurance Companies and/or Patients.
Once balance is identified correctly, claim balance will be billed to the right balance to the correct patient balance or to the correct insurance carrier with correction of the claim for resubmission processing.
Help our SWAT Team to finalize the provided project to finish for the target deadlines.
08/19 – 09/19 Account Receivable Specialist MMC Hospital, Brooklyn, NY
Review all Explanation of Benefits from all Insurance Companies final payments and/or denials of payments posted and verify if the denial reason is correct.
Review balances for claims unpaid by Insurance Companies and/or Patients.
Once balance is identified correctly, claim balance will be billed to the right balance to the correct patient or tot the correct insurance carrier.
Create an Appeal Letter to the right Insurance with corrected modifier as well as attached copies of medical records for the Date of Service provided.
Once an Appeal Letter is created and a Medical Record is provided, the supervisor will review all paperwork for approval before sending it to the right Insurance Carrier Provider.
When Documents are approved by the Supervisor, the Appeal Letter will be sent and Re-billed all approved denials and all patient balances.
Follow up for an Appeal submission to assure all the claims gets paid afterwards.
05/04 – 04/19 Accounts Receivables/Payroll/Medical Biller Interboro Health & Heart, Brooklyn
Hospital, Brooklyn NY
Print, Collect, and Analyze patients’ demographic information obtained from EAGLE System Program.
Verify updated diagnosis and procedure coding, pre-cert, and eligibility of patients to guarantee of payments.
Create a new claim database to bill Insurance Companies.
Create EMC for Electronic Transmission to the Clearing House for Medicare Part B, NEIC, Medicaid, Medicare GHI, Blue Cross Blue Shield.
Review and Follow-up all Electronic Transmission Result for the Validation Reports of all transmitted claims to ensure all claims are received on time by the Insurance Companies.
Review billing claims prior to submitting to Insurance Companies to ensure acceptance and payments of claims.
Manage all Explanation of Benefits from all Insurance Companies regarding final payments and/or denials.
Review all Explanation of Benefits from all Insurance Companies final payments and/or denials of payments.
Review Postings and Create Journal Entries for claims paid by Insurance Companies.
Re-bill all approved denials and all patient balances.
File an Appeal to Insurance Companies that denied payments for claims. Follow up to make sure it gets paid afterwards.
Reviewed and Prepared all accounting records quarterly and yearly reports for charges and collected payments.
Bi-weekly, Collect all Timesheets from the Supervisor for all Employees via email.
Prepare Worksheets for Total Regular Hours, Sick Request, Personal Day Off Request, and Vacation Request per Employee to verify the available hours to be paid and recorded correctly.
Report to ADP all completed hours to be paid per Employee.
Keep Track of the Record for the Accrued Hours for Sick, Personal and Vacation for Each Employee to assure that everyone is not going to over-use more than the Benefits Provided by the Employer for each individual Employees Coverage.
Create Monthly Payroll Expenses Report for Dr. Sarath Reddy and Dr. Swaminathan Chennareddy for some Employees to be provided to the Brooklyn Hospital Payroll Department for reimbursement of Employees Expenses.
10/13 – 02/17 Medical Assistant/Medical Biller/Account Receivable Orthotics Consultants, Inc. NY
Part-Time
Verify and Update Scheduling for the Patient Appointments, Charts, Medical Records for the claim will be back-up with documentation done for the service in-case of Insurance Auditing.
Collects Patient’s Demographic Information, verifies and requests updated diagnosis and procedure coding, pre-cert, and eligibility, of patients to guarantee of payments.
Create a new claim database and by HCFA Form Paper to bill Insurance Companies on a daily basis with copies of Medical Records.
Review billing claims prior to submitting to Insurance Companies to ensure acceptance and payments of claims.
Review all submitted claims to ensure all claims are received on time by the Insurance Companies.
Review all Explanation of Benefits from all Insurance Companies final payments and/or denials of payments.
Re-submitted all approved denials and all balance of the claims to Secondary Insurances and/or Patient Responsibility for the Co-Insurance/Co-Payment/Deductible Balance of the claims.
File an Appeal to Insurance Companies that denied payments for claims. Follow up to make sure it gets paid afterwards.
06/16 – 02/17 Accounts Receivable/Accounts Payable/Collector Tristan World Travel Corp.
E 98th Street, Brooklyn, NY
Part-Time
Receives & Makes Phone Calls for all Travel Agencies based on the Assigned Location to verify the cheapest Cruise and Flight service offers for the chosen date of departure/arrivals.
Finalized the Total Price per Head for the Final Trip assigned with Cruise and Flights Coverage.
Review Created & Decorated Flyers based on designed chosen by the company.
Make additional information to Flyers to add all Schedules and Itinerary and Price with payment details and demographic information to be filled out per client.
Receives & Makes Phone calls for all client’s payments based on deadlines provided before the trip departure date.
Collect all the copies of Passport, Demographic Information that required for the Trip both for the Flight and Cruise Internationally such as proof of citizenship or Visas if needed.
Collect all client’s payments via checks or money order or by credit card.
Make sure all collected payments are recorded per client.
Make sure all Balance Due to Cruise and Flights assigned has been paid completely before the deadlines of payment prior to Departure Date.
Prepare all the client’s demographic information to be submitted to Flight and Cruise to assign the seat and rooms to check-in during departure.
Prepare all Name Badges Needed per Client to make sure the Travel will be organized based on their assigned Name Badge.
Assure that the clients are satisfied and enjoyed their Journey of the Trip with the TWT.
07/04 – 12/12 Account Receivables/Medical Biller Satish Reddy, M.D. New York, N.Y.
Verify updated diagnosis and procedure coding, pre-cert, and eligibility of patients to guarantee of payments.
Create a new claim database to bill Insurance Companies.
Create EMC for Electronic Transmission to the Clearing House for Medicare Part B, NEIC, Medicaid, Medicare GHI, Blue Cross Blue Sheild.
Review and Follow-up all Electronic Transmission Result for the Validation Reports of all transmitted claims to ensure all claims are received on time by the Insurance Companies.
Review billing claims prior to submitting to Insurance Companies to ensure acceptance and payment of claims.
Review all Explanation of Benefits from all Insurance Companies final payments and/or denials of payments.
Review Postings and Create Journal Entries for claims paid by Insurance Companies.
Re-bill all approved denials and all patient balances.
File an Appeal to Insurance Companies that denied payments for claims. Follow up to make sure it gets paid afterwards.
05/09 – 09/11 Medical Billing Collector Integra Partners LLC, Brooklyn, NY 11234
Receives & Makes Phone Calls for All Providers and Insurances based on assigned Insurance Carrier for Review of billing claims prior to submitting to Insurance Companies to ensure acceptance and payments of claims as per Contract.
Review all submitted claims to ensure all claims are received in a timely manner by the Insurance Companies with proper pre-cert, diagnosis, and procedure codes payable as per Insurance Contract.
Review all unpaid claims from all Insurance Companies final payments and/or denials of payments.
Re-submitted all approved denials and all balance to the claims to Secondary Insurance.
File an Appeal to Insurance Companies that denied payments for claims. Follow up to make sure it gets paid afterwards.
Update Providers for all the denied claims due to lack of information (eligibility, pre-cert, updated diagnosis and procedure codes, and medical records) needed as per contract to ensure the future error can be prevented for claim to be paid.
Ensure all Monthly Report for the Aging Report has been updated on a timely manner for all Providers Pending Claims per Assigned Insurance Companies.
01/01 – 05/04 Store Manager Laundromaxx, 86th Street, Brooklyn, NY
Maintained Customer Records and Responded to Customer Inquiries.
Trained and Supervised Staff.
Maintained the Orderly and Cleanliness of the Store.
09/11 – 12/01 Student Aid Kingsborough College Library, Brooklyn, NY
Assisted Faculty in setting up research using Internet Tools.
Helped Students with research using Microfilm Reader Printer.
09/98 – 06/99 Accounting Manager All-Star Sporting Goods, Sheepshead Bay of High School Brooklyn, NY
VIRTUAL ENTERPRISE PROGRAM
Reviewed and Prepared all Accounting Records.
Maintained Financial Status of the Financial Transactions.
Represented the Organization at N.Y. Business’ International in Vienna, Austria
EDUCATION:
February 2005 Bachelor in Business Administration The Bernard Baruch College, CUNY
Major: Accounting
June 2002 A.A.S. Degree & A.S. Degree Kingsborough Community College
Major: Accounting & Entrepreneurial Studies
Extra-Curricular Activities: Editor of Yearbook 2002
Awards: The Lenny Goldman Scholarship
Award: Dean’s List
CERTIFICATION:
June 2005 Licensed Notary Public Brooklyn, New York
June 2006 Certified Medical Billing The Manhattan Institute
SKILLS:
VLOOKUP
PIVOT
FloQast
Sage
Evero
Therap
Box
Paycom
UKG
RPM System
Doc-tor.com
MDOffice
Peachtree Accounting
Microsoft Word/Microsoft Excel/Microsoft Access/Microsoft PowerPoint and Other Microsoft Office Programs
Mac QuarkXPress
Teams
Outlook
Graphics and Scanning
REFERANCE FURNISHED UPON REQUEST
Contact this candidate