Anna M. Brijil

**** ***** **., **********, ** ***67

Cell 661-***-****

Summary

Seeking a position within a well-established company that offers challenging opportunities, utilizes my skills, and provides an opportunity for advancement.

Work Experience

MEDICAL CITY ARLINGTON Arlington, TX

June 19, 2023 – Present

HIM Specialist

Processing medical record requests by in person patient request.

Cover the duties of receptionist.

General clerical duties including photocopying, fax, mailing, filing (electronic and paper), sorting and distributing correspondence.

Upload Subpoenas to the online database for processing.

Assists other employees as needed.

Performs other duties as assigned by the Director.

Processes requests for medical information from outside hospitals, clinics, and physicians

Assists Billers, and Coders through eRequest by obtaining documentation that is being requested for billing.

Working applicable worklists within 3M 360 Encompass, resolving unbilled accounts, routine data entry of unbilled reason codes (URCs)

Retrieving medical records and loose documentation from ancillary departments and nursing units, prepping, scanning, and indexing of the documents into HPF/MPF or E.H.R

Performing quality checks of documents scanned

Processing HIM incoming mail request and faxing to ROI.

Processing physician suspensions, assist with the physician suspension process by evaluating if a physician should be put on suspension, creating the list of recommended suspensions for approval, sending out notice letters, making reminder calls, etc..

IKON PAIN MANAGEMENT Midlothian, TX

August 30, 2022 – March 24, 2023

Biller/Collector/Front Office

Submit claims to all payers through ATHENA.

Prep and review denials for possible appeal/rebill.

Review EOBs: Ensure claim paid per negotiated rate.

Adjustments to accounts when needed.

Follow up with payers on claim status and document appropriately, and Re-bill when needed.

Check eligibility. Obtained authorization for procedures.

Collect and Post Patient payments, along with setting up payment plan.

Post Payer payments.

Perform a wide variety of duties in support of the office, which include assisting patients with registration.

Answer the phone, return patient phone messages and emails, and make confirmation calls in a professional and courteous manner.

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Accurately schedule, change, and cancel appointments.

Check patients in and out and schedule any needed appointments.

Maintaining flow of patient check-in and check-out, verifying up-to-date demographics and insurance information within patient’s medical records.

Rooming patients, taking vitals and detailed patient histories, documenting all patients.

Record patient care documentation in the medical record accurately and in a timely manner.

Prep charts to assure that all information required for patient visit is available for the provider.

Clean and prepare exam rooms which include restocking medical supplies.

Continuously communicate with the provider concerns cancellations, reschedules, no-shows, and specific needs of patients on the schedule

Collect and prepare laboratory specimens.

Update electronic medical records.

Medical Records scanning

Open and Close facility.

Henry Mayo Newhall Urgent Care Valencia, CA

December 14, 2018 - November 8, 2019

Biller/Collector (Remotely)

Submit claims to all payers through ATHENA.

Prep and review denials for possible appeal/rebill.

Review EOBs: Ensure claim paid per negotiated rate.

Adjustments to accounts when needed.

Check eligibility and update accounts for re-bill.

Follow up to payers on claim status and document appropriately.

Post Payer payments.

Correct patient accounts as needed, to include adjustments.

Cedars-Sinai (affiliate Marina Del Rey Hospital) Los Angeles, CA

Was transferred to Cedars-Sinai July 10, 2017 – July 20, 2018

Patient Financial Services

Perform a wide variety of duties in support of the department, which include assisting patients.

Accurately posts patient payments and credits to accounts.

Take incoming calls related to patient statement/balance inquiries. Set up payment plans for patients and perform collection activities. Explain and provide financial policies and available resources for alternative payment arrangements to patients and their families.

Handling of self-pay accounts for full payment, partial payment or long-term payment arrangements.

Verify insurance eligibility benefits for services rendered with the payors and document appropriately.

Handling customer inquiries regarding patient account receivable. Inquiries received via the mail, fax, telephone and/or in person. Research and resolve patient inquiries

Reaching out to patients via telephone informing them of their outstanding balance and the reason for the balance

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Keeping track of necessary follow-ups/escalations

Complete PFS tasks

Process PFS e-mail tasks

Correct patient accounts as needed, to include adjustments

Make outgoing soft collection calls as assigned

Return phone calls as a result of the voicemails left by patients or clinic staff

Train other staff members as requested.

Marina Del Rey Hospital (Cedars-Sinai affiliate Hospital) Marina Del Rey, CA

January 2, 2009, to July 9, 2017 - Was Transferred to Cedars-Sinai

Billing Coordinator/Collector

Assist Director of Revenue Cycle along with ER Manager with Special projects including day to day duties.

Coordinate billing work list for billers to insure maximum production.

Identify and correct account information when applicable; update patient demographic information in Siemens in order for ePremis to be in sync.

Submit claims to all payers through ePremis upon receipt of daily claims submissions from hospital’s patient accounting system.

Review accounts daily to insure all accounts are being billed correctly and in a timely manner.

Monitor daily to insure that all accepted claims are being released during the scheduled time assigned and that the system is functioning properly. Coordinate with ePremis, hospital’s electronic billing system vender to resolve system issues that may occur.

Generate daily hold reports to make sure requested claim information is accurate and received in a timely manner. (Medical records, coding issued, claims corrections).

Write payers’ edits to improve validation rate to 90% evidenced by daily claims submission report.

Work cohesively with providers, insurance carrier, and facility case management

Prep and review denials for possible appeal.

Prep and review denials for Retro Review, Obtained Medical Records.

Work all Credit Accounts- audit adjustments, & review payments.

Review EOBs: Ensure claim paid per negotiated rate.

Review and Process daily Billing for all Commercial, Managed Care and Government Managed Care claims.

Mail all paper claims to payers and any documents as needed.

Review all In-Patient and Out-Patient HMO accounts that an authorization was obtained for service. Following up with financial counselors daily with those accounts not approved before releasing claim.

Daily QA on registration

Work closely with case management for those accounts that have a denial for non- medical necessity and obtain a letter of medical necessity for Patient stay /procedure for a payable bill. Also sending out a weekly report to them for all claims that have denied. Obtain a LOMN for these accounts to be re-processed.

Send out a daily follow-up report to the front-end registration department to obtain health and work comp insurance information for those accounts that are pending insurance information from patients.

Assist staff with any problem accounts.

Perform other duties as assigned.

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Kaiser Permanente Pasadena, CA

January 3, 2007, to December 31, 2008

Contractor with HRG - Project Manager

Assist Assistant Director of Revenue and Banking Services along with Regional Supervisor of North Operations, Regional Supervisor of South Operations and Supervisor of Research Unit with Special projects including day to day duties.

Maintain 34 Payment Posters productivity from both divisions in a report that is given to the Assistant Director.

Maintain attendance calendar for 40 employees for each Regional Supervisor.

Daily QA review on Posting Batches for 34 payment posters.

Due corrections on Posting Batches and keep log on Poster’s errors.

Review errors with the Poster’s and assist them when needed in making their corrections.

Contact Payors to have them add any missing information such an account numbers or service descriptions on the EOR’s that is required for posting. I’m continuously following up with Payors until the issue is resolved and we have a corrected EOR for entry and closing of the batch

Assist Reimbursement Analyst with their data entry - when they are out of the office, or their work is backed up.

Quarterly do a Payment Posting Audit on all the Poster’s for North and South Operations

Prepare/Maintain Quarterly SOX review report on 34 payment posters

Assist Auditors throughout the year with on task that is needed on Quarterly SOX review

BROTMAN MEDICAL CENTER / Culver City, CA

PEROT SYSTEMS HEALTHCARE

September 1, 2005, to January 2, 2007

Terms & Conditions Supervisor / Hospital Collector Supervisor for HMO / PPO /

Managed Care/Customer Service Supervisor

Work directly with CFO, Assistant CFO, Director and Manager of Business Office with Special projects

Maintain and perform month end analysis of contractual allowance for month end reporting.

Work closely with CFO & Assistant CFO after month end review

Assist BOM with special projects and assist in contacting payers to assist with payment of pending claims.

Contract management

Review all new managed care contract’s terms and conditions.

Obtain, review and negotiate new/old contracts and complete new applications.

Maintained existing contracts and files for Hospital

Notify Business Office Director of any pending contact expirations.

Continuously update databases with contract changes due to conversion

Contact person for all Managed Care Issues

Review case rate on a regular basis for Medical Groups and Health Plans

Responsible for distribution of all contract information to required departments/facilities.

Work on daily adjustments to have clean accounts for month end

Net patient accounts down to correct insurance reimbursement

Provide training to appropriate staff to read and interpret contracts.

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Distribution of assignments to staff members as well as reviewing completion of their work.

Solving customer services and insurance issues

Check eligibility, verification, Obtain authorizations/referrals for services

Review, analyze and collect on outstanding receivables on patient accounts

as assigned per client specifications

Assists patients and insurance companies in resolving problem account balances, and perform collection follow-up on accounts.

Preparing denied claims for rebilling

Track progress on resolutions for patient accounts

Review and assist patients and insurance companies in their overpayment

refunds request.

Absolute Control Services, Inc. Los Angeles, CA

Contractor at Orthopedic Hospital

June 10, 2002 - August 31, 2005

Payor Contracting Specialist / HMO Coordinator

Hospital Collector for HMO / PPO / Managed Care / Medi-Cal for In & Out Patients

Maintained existing contracts and files for Hospital and Physicians

Maintained positive relationships with Health Plans to insure maximum reimbursement.

Continuously update databases and Payors based upon changes made in Hospital.

Assist Director of Patient Accounts with Special projects

Collection on all HMO/PPO/Managed Care/Medi-Cal accounts

Collection on Private Pay accounts

Preparing for denied claims for rebilling.

Track progress on resolutions for patient accounts

Check eligibility and verification.

Obtain authorizations/referrals for services.

MD Services / Health Check Information Center Westlake Village, CA

(Contract Basis) July 1, 2002 - August 15, 2003

Network Administrator / Payor Contracting Specialist

Obtain, review and negotiate new contracts and complete applications for imaging centers.

Continuously update databases and Payors based upon changes made in Radiologist, in center address, change in ownership (change in TIN), in lockbox, change of legal or DBA name, change in terms of contract, new modalities.

Acquired data for opening of new imaging center business.

Research articles and information for website, Assisted in designing website for new network

Design market materials, Market clients for network

Schedule appointments for network, Insurance verification for imaging centers

Preparing reports for each imaging center - (Patient and Physician count for each month)

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Comprehensive Medical Imaging / SYNCOR Woodland Hills, CA

June 19, 2000- June 7, 2002 - Payor Contracting Associate

Obtain, review and negotiate new / old contracts and complete new applications for over 64 imaging centers (multi-modalities)

Maintained existing contracts and files.

Acquired data for opening of new imaging center business.

Responsible for distribution of all contract information to required departments/facilities.

Continuously update databases and Payors based upon changes made in Radiologist, in center address, change in ownership (change in TIN), in lockbox, change of legal or DBA name, change in terms of contract, new modalities.

Assist Manager with Special projects.

Distribution of assignments to staff members as well as reviewing completion of their work.

In charge of all National and Regional contracts along with individual center contracts.

Valley Presbyterian MR Center (US Diagnostic, Inc.) Van Nuys, CA

March 7, 1994 – June 16, 2000

Front Office Registration / Administrative Assistant / Office Manager

Assistant to Center Manager and Marketing Representative in day-to-day duties.

Contract Management Manager, Film Library Department and Payroll

Maintained existing contracts and fillies.

Insurance verification for 3 Out-Patient Imaging Centers.

Solving customer service and insurance issues.

Coordination of daily schedules for 3 Out-Patient Imaging Centers (2 MRI only and 1Multi-modality).

Patient registration, Patient scheduling, Data Entry

Distribution of assignments to staff members as well as reviewing completion of their work.

Other duties as required.

Universal Medi-Co Monterey Park, CA

August 17, 1987- November 27, 1992

Front Office / Insurance Verification / Coordinator / Supervisor

Patient Registration including Chart preparation.

Patient Scheduling, Answer phones, Insurance verification, and Obtained Authorization.

Collect and Post Patient payments, along with setting up payment plan.

File / Copy Records, Data Entry

Send out a daily follow-up report to the front-end registration department to obtain health and work comp insurance information for those accounts that are pending insurance information from patients.

Assist staff with any problem accounts

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