PRISCILLA A CRUZ

210-***-****

ad3wkr@r.postjobfree.com

***** ***** ***** *** *******, TX 78254

OBJECTIVE :

To bring accurate knowledge and Support in Medical Billing & coding to the organization. SKILLS

• Supervisor/Manager Skills

• Proficiency in Medicare /Medicare

Replacement /Managed Care, all Commercial

Insurance Billing

• Microsoft Office

• Computer proficient

• Multitasker

• Problem resolution ability

• Claims analysis and review specialist

• Medical coding

• Proficient in Medical Terminology.

• Patient

• Report Building

• Expertise in TWC billing

• In-depth claims knowledge

• Bi-lingual in English and Spanish

• 10 Key Proficient

• Cheerful and energetic

• Proficient in Billing for Wellmed and billing

needed codes to close measurements.

• Adaptive team player

• Detail-oriented

• Time management

• Organized

• Energetic work attitude

• Software knowledge includes MOMS, EMDS,

and Athena.

18 years of Experience in Medical Billing.

**Experience in billing for Family Medicine,

Dermatology, Chiropractic, Urgent Care and

Pediatric.

EXPERIENCE

BILLING MANAGER 11/14/2018-02/16/2024

SAN ANTONIO FAMILY PHYSICIAN'S 5230 ROGERS RD SA TX 78251 Ensured accurate, compliant, timely coding, billing and appropriate reimbursement for our medical professional services from various insurance payers and patients. Responsibilities included dropping claims in the missing slips bucket, working the hold and manager hold buckets, correct and timely collection of unpaid patient accounts, re-billing, adjustments and appeals. Worked cooperatively as a team and demonstrate behaviors of trust and respect toward others including clinical staff, physicians, associates and management. Created and developed a system for the Benefit and Eligibility staff person in checking the upcoming schedule for patient coverage, collection amounts, and pending balances. Created a benefits sheet that could be imported into the patient's chart with the most common service provided in the office that could apply to deductibles, coinsurance, or copay. Added alerts to patient’s charts regarding coverage and amount to collect. Call patients if balances are over $50 to try to collect or advise patients to come prepared to pay at the appointment. (Work from Phreesia dashboard five days in advance of the visit). Sent patients links to complete forms, Payments or send attachments back to our office to be reviewed prior to their appointment. Prepared and submitted clean claims to various insurance companies in accordance with specific payer guidelines and/or contract requirements. Worked on Pending claims that had Primary and Secondary holds due to missing info ex, Incorrect NDC, missing subscriber’s info for completeness and accuracy of information for second-pass clean claim submission. Researched and performed all primary and secondary billing claim status follow-up activities for insurance plans. Reviewed, evaluated, and processed all claim appeals through resubmission to insurance carriers with complete and accurate supporting documentation required. Reviewed Un-postable Dashboard: In the Practice column of the dashboard. Ex: No matching charge/patient, balance forward, and old date of service items. Researched and recommended any customer account adjustments and/or write-offs to Manager based upon collectability of account with insurance carrier or patient. Submitted any refunds for approval and process if applicable. Refunded patient’s late night and weekend deposits after any pending payments or charges. Close any posting batches used to post transfers, adjustments, or refunds daily. Run and audit Zero Pay Report: Review closed charges that received a zero payment and were adjusted off, based on the primary insurer’s payment rules: appeal any claims that qualify. Or adjust under proper custom adjustment code needed for tracking purposes. Recognized and report claims problems, errors, and discrepancies to management to proactively identify and effectively resolve billing trends in a timely manner. Verified and assured that all outside vendor invoices had corresponding charges paid to support payment to vendor. EX. Vaccine company invoice to Clinic, Echo/ultrasound invoice. Provided feedback for documentation & coding to Physicians. Assisted Physicians in accurate coding in order for tests to be covered by insurance. Reported on a weekly basis a list of outstanding claims/open notes to keep physicians current with Charges and signed notes. Created Billing and Front desk tests for incoming new hires to get baseline of their knowledge coming in. Trained both staff if further training was needed to get them up to speed with our office policies and procedures. Created cheat sheets for front desk personnel as well as for the physicians and all clinical and non-clinical staff. Medical Billing Specialist 1/05/2008- 10/ 05/2018

Bandera Family Health Care San Antonio, TX 78249 Main Charge Entry Person for 3 locations including an Acute Care clinic, Allergy clinic

(Percutaneous skin test, weekly shot and Serum Billing), Osteoporosis Clinic (Bone density Scans, Reclast and Prolia Infusion Billing), Wound care Billing (Packing and wound debridement ), Infusion Treatment Center (IV med or hydration therapy), Cardiac Billing including Echo and Stress (Dobutamine) Test billing, Diabetic Clinic (Glaucoma, Retina Fundus and CGM), X-ray and Lab Billing . Proficient in Medicare/ Medicaid and commercial Billing. Payment Poster for all Medicare and its Managed Care products. Daily Payment reconciliation. End of the Month reconciliation for Charges and Payments. End of the Month reconciliation for all ancillary and Office visits to ensure all services have been captured and billed. Weekly data reports analysis for Providers. Home Health monthly Billing for commercial and Medicare/Medicaid Insurance. Proficient in Accounts Receivable for Medicare and commercial plans. Patient collections and Monthly statement process. Patient Account Collection placement with Outside collection agency. In charge of Making Department monthly schedule for tasks such as Phone Rotation, Voicemail retrievals and calls backs, Lunch Schedule. Excellence in Patient Customer Service assistance with Bills or Insurance questions.

Billing Specialist 03/05/2006- 09/05/2008

Bilcorp Medical Billing Services, Inc. San Antonio, TX Main Charge Entry person for Multi -Specialty Practices. Payment Posting for all commercial and Medicare Products. Lab Billing for Medicare and Commercial Plans. Daily reconciliation Report for Phsycians to show AR and total payments collected. EDUCATION AND TRAINING

2004 :High School Diploma: High school diploma Indio High School Indio, CA, GPA: Education and Training

2007 :Certificate: Medical Billing & Coding College of Healthcare Professions San Antonio, Texas

2020: Microsoft 365 Certified: Fundamentals of Microsoft Excel, Word and Power Point. Completed 150 hours of instruction and hands on experience- Saint Phillips College, San Antonio TX

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