Luciana Van Buren

**** **** **.

Fort Worth, Tx. 76244

415-***-****

ad3r33@r.postjobfree.com

HIGHLIGHT OF QUALIFICATIONS

● Over 25 years of Medical/Dental, billing, collecJons, claims processing, A/R & A/P,

● Hospital/Physician Billing and CollecJons

● Knowledge of NQCA/HEDIS standards

● Strong analyJcal and communicaJon skills; self-moJvated, people-oriented and dependable

● Experience in working with various medical billing so[ware: Next-Gen, Office Ally, Gateway, Proxy Med, Mediso[, IDX, Centricity, QuickBooks, OSD, EPIC, EHR, EDI, APEX, Cure MD, Oracle, Plush Care Admin panel, etc...

● ICD-9/10 and CPT coding proficient

● Experienced working Government, Commercial, Workers CompensaJon and TPL (Third Party Liability), supplement, secondary, HMO and PPO claims

● Knowledge of Windows, MS Word, Excel and MAC

● Medical Terminology

● Ability to read/interpret an EOB/ERA

Experience

Boson Health/Aqua Dialysis – Fort Worth Tx. 01/2022 – 07/2023 Medical Billing/Collec/ons Rep.

Responsible for billing Dialysis claims electronically/manually for 6 faciliJes at the beginning of every month, outbound calls to insurance companies regarding missing or parJal payments, review and resolve correspondence received, Appeal claims, mailed/faxed requested informaJon, run/complete monthly billing reports, worked various accounts via excel spreadsheet, adjust/correct paJent accounts. CDE Medical Associates - San Carlos, Ca. 04/2021 - 07/2021 Medical Billing/Collec/on Specialist

Outbound calls to paJents regarding balances on account, Updated billing guidelines, follow-up on unpaid bills, review and resolve aged claims, assist manager with sejng up billing office, collected and posted paJent payments, update paJent demographics and insurance informaJon, verified insurances, adhere to confidenJality policy and HIPAA compliance and provide excellent customer service. Plush Care of California - San Francisco, Ca. 12/2018 - 06/2020 Billing/Collec/ons Specialist

Electronic billing of claims for Tele-Medicine start-up company, follow-up on previously billed claims, re-bill claims when necessary, verify paJent insurance, update paJent profile, reviewed and worked aged claims, pivot-tables, create spreadsheets for problem claims, ICD-10 and CPT coding, administer authorizaJon requests for scheduled procedures, IdenJfy and resolve trends prevenJng payment of claims and escalaJng such issues to the manager if needed while providing excellent customer service.

Ask Staffing - Alpharela, Ga. (UCSF) 09/2018 - 12/2018 Sr. Collec/ons Rep.

Examined and evaluated accounts for appropriate follow-up acJon, review and submit professional claims, post payments and adjustments, submit requests to OB/GYN offices via email, phone calls or RFI’s, validate credit balances and refunds, answer incoming calls, educate paJents of their benefits, compose appeals and mail outpaJent statements. Review and resolve correspondence and maintain excellent customer service.

Account Temps - Fort Worth, TX 03/2018 - 07/2018

American Outcomes Management

Accounts Receivable Specialist

Electronic hospital billing for Home Infusion Therapy procedures, follow-up on previously billed claims, review EOB for accuracy of payments, compose appeal leler for unpaid or parJally paid claims, re- submit bills with proper documentaJon for reimbursement, worked consistently with provider reps to ensure receipt of bills, complete daily spreadsheet of accounts worked and completed, review and resolve correspondence received from insurance companies, idenJfied trends that caused payment delays or improper claims submissions, worked aged account of over 120 days, review medical records, update paJent profile, verified insurance coverage, conducted complaints to the state Board of Insurance regarding non payments per our leler of Agreements or fee schedule, HIPAA compliant, received incoming calls from paJents regarding their accounts, mailed out paJent statements, made payment arrangements for paJents with balances and provide excellent customers. Health Drive - Fort Worth, TX 10/2017 - 01/2018

Reimbursement Specialist

Dental billing, processing and provide financing opJons to paJents and nursing homes, follow-up on invoices sent for payment, adjust accounts, balance and post payment in paJent account and QuickBooks, mail out 1263/1054 forms along with the treatment plans to the state Medicaid office to get Dental services approved for the paJents at the nursing home, kept track of the procedures performed on paJent, answer and forward all incoming calls, provide account informaJon to the responsible party of the paJent, worked aged account on spreadsheets and log daily producJvity, adhere to HIPAA regulaJons and maintain confidenJality while providing excellent customer service. IKS Healthcare - Fort Worth, TX 09/2016 - 01/2017

Payer Analyst

Follow- up with insurance companies regarding previously billed claims, reviewed/ posted payments from EOB/ERA, composed denial lelers/ReconsideraJons, idenJfied issues that delayed processing and payment of claims, process credit-card payments, receive/review and distribute incoming mail, worked accounts via spreadsheets, documented daily producJvity, worked daily correspondence received and answered incoming calls regarding paJent accounts. US Anesthesia Partners – Arlington, TX 12/2015 – 09/2016 Pa4ent Account Rep II

Follow-up with insurance companies for payment status of previously billed hospital claims, process and follow-up on appeals/ reconsideraJons to insurance companies, contact paJents regarding balances on the account, print/rebill claim as needed, work daily correspondence, answer/resolve all incoming calls received in Queue, research/audit paJent, accounts, post payments from EOB/ERA, work Analyzer report as assigned, compose and worked from spreadsheets, worked outstanding AR from Collector queue, completed 45-55 accounts daily, meet producJvity standards as set by department and adhere to company policies and procedures, adjust account accordingly, update paJent demographics and insurance informaJon for billing purposes and provide excellent customer service. Christus Health – Fort Worth, TX 01/2013 - 12/2015 Medic al PFS Associate III-/Collector Validator

Responsible for processing ub-04 bills, collecJons and reimbursement services of claims and duJes to hospitals supported by the RCBS. In doing so, ensures that all claims billed and collected meet all government mandated procedures for Integrity and Compliance. Perform billing, collecJons and reimbursement services of hospital claims in a prompt and efficient manner. Provide thorough, courteous and professional assistance to paJents, physician offices, Insurance companies and other clients on an as needed basis while maintaining strictest confidence. Document, forward and resolve incoming mail and correspondence. Making sure claims are paid correctly and handling any denials with the claims.

Aerotek Staffing/American Anesthesiology – Arlington, TX 08/2013 - 11/2013 Medical Collec4ons Specialist

Responsible for billing UB-04 claims for Anesthesia, collecJons and reimbursement services of hospital claims, follow-up on authorizaJons for upcoming procedures, contact payers to check claim status and reimbursement, follow-up on outstanding accounts by working collecJon reports and correspondence, review and work all daily correspondence received from paJents and payers, perform audits on accounts when needed, process refunds for overpayments made by payers and/or paJents, process adjustments as necessary, appeal denied claims via mail or telephone, conduct all business in a professional manner maintaining respect for individuals, maintain strict confidenJality in accordance with HIPAA regulaJons and Company policy, contact paJents /responsible party to obtain accurate insurance informaJon, review and resolve specific denials posted from EOB’s received, adjust account to reflect payments received and balances due.

Manpower/ SPS – Sacramento, CA 09/2011 - 01/2013

Account Representa/ve II

Responsible for performing billing, collecJons and reimbursement services of Workers’ CompensaJon claims, follow-up on previously billed claims for accuracy of payments, post payments via ExplanaJon of Benefits, review and complete aged accounts. Provide thorough, courteous and professional assistance to paJents, physicians and other clients while maintaining the strictest confidence. Assist with the LiJgaJon process of claims. Update and adjust accounts as needed. Document, forward and resolve incoming mail and correspondence.

Katrina Billing Services – Elk Grove, CA 04/2009 - 08/2013 Medic al Reimbursement Specialist

Reviewed super bills for accuracy of procedures performed, light coding of ophthalmology procedures performed, performed billing, collecJon and reimbursement services of claims for various physician offices, reviewed and completed aged bills and reports. Appeal disputed claims, when necessary, post and adjust payments and resolve billing issues and document all claims worked.

Dr. Cecille Taylor Ophthalmology – Folsom, CA 12/2008 - 04/2009 Office Manager/Billing/Collec4ons

Responsible for the operaJons and administraJon side of a medical office, Hire, terminate, and train staff in a medical office as needed, reconcile account informaJon, maintain physician contracts and ensure all credenJaling is up to date, maintain daily bank deposits and assist with payment arrangements for the paJents. Perform billing, collecJon and reimbursement services, implement new procedures and policies to ensure the office is run smoothly and efficiently. Document and forward all incoming mail while maintaining strict confidenJality and performing staff evaluaJons.

Dr. Roy Rubin Orthopedics - Sacramento, CA. 08/2006 - 09/2008 Medical Billing Specialist

Responsible for coding and billing of in office visits and surgical procedures performed daily, reviewed EOB for accuracy of payment per the contract, submit denial lelers regarding parJally paid/unpaid claims, update paJent insurance informaJon and post payments to accounts, resolved aging of over 120 to 30 days within 2-3 days, review and resolve daily correspondence received, review all charge entry forms, schedule doctor surgeries, scan/upload documents, ensure Dr. credenJals are current, administer payment arrangement with paJents while maintaining and adhering to company rules and policies and provide excellent customer service

Educa:on

City College of San Francisco • General EducaJon • San Francisco, Ca. (1993) (2019 – 2021) C.E.T.S Program • CerJfied Nursing Assistant • San Francisco, Ca. (1993) Trinity College • CerJfied Medical Assistant/Phlebotomy/Billing • San Francisco, Ca. (1998) American River College • Business • Sacramento, Ca. (2011 – 2013)

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