Sonia M Gonzales

Mesquite, Texas *****

945-***-**** ad4mhs@r.postjobfree.com

Skills

● Communication skills

● Active listening

● Problem-solving skills

● Insurance Knowledge

● Attention to detail

● Medical terminology

● Knowledge of coding systems

● Customer Service Skills

● Attention to Detail

● Clear Communication Skills

● Time Management

● Organization skills

Experience

Referral Coordinator Dr. Salma Mazhar August 2023 -November 2023

• Verified insurance benefits.

• Responsible for referrals when needed.

• Submitted request for approval to the payors.

• Submitted clinicals when needed.

• Assisted front desk with check in/out.

• Answered phones.

• Scheduled patients through Athena

PRIOR AUTHORIZATION White Rock Medical Center, Dallas - March 2023- August 1. 2023

● Performed Benefits Verification

● Maintain contact management regarding status of authorization and any additional documentation or information needed

. ● Obtaining detailed benefits for ordered test

● Adjudicated and resolved insurance issues for patients on inpatient stays, communicated with other medical professionals to obtain expensive procedures.

● Scheduled P2P when needed

Medical Biller Methodist CBO 12/2022-03/2023

● Worked on claims, denials, appeals, and aging reports to determine the appropriate follow-up actions.

● Identified and corrected billing errors and re-submitting claims to insurance carriers.

● Reviewed claims for covered, non-covered items, diagnosis, modifiers, valid HCPC authorization, and eligibility.

● EPIC, Cerner

NOCD Medical Billing Specialist February 2022- August 2022

● Posted and adjusted payments from insurance companies

● Located errors and promptly refiled rejected

● Precisely evaluated and verified benefits and eligibility.

● Communicated effectively and extensively with other departments to resolve claims issues.

● Communicated with insurance providers to resolve denied claims and resubmitted REIMBURSEMENT SPECIALIST I CAREMETX, LLC I 12/2021- 02/2022 [TEMP]

● Responsible for validating patients billing information verify and obtain information concerning insurance benefits Obtain authorizations from insurance companies

● Obtain prior authorizations for high value pharmaceuticals

● Utilized Athena EMR to document all information and outcomes in the Patient Accounting System.

● Interprets complex payer coverage information including, but not limited to, network participation status with a provider, limited plan coverage, and inactive benefits MEDICAL COLLECTOR/BILLER ICERGIS

12/2020-03/2021 [TEMP]

● Performed targeted collections on past due accounts aged over 160 days. Reviewed, analyzed and

● managed coding of diagnostic and treatment procedures

● Applied charges and updated patient records by using Zirmed and Availity

. ● Correctly coded and billed medical claims for Washington Count

● Reviewing patient bills for accuracy and completeness and obtaining any missing information.

● Preparing, reviewing, and transmitting claims using billing software (electronic & paper claim processing.)

BENEFIT ADVOCATE, ALIGHT SOLUTIONS I DALLAS, TX. 05 /2018- 11/2020

● Resolved issues and inquiries from plan participants regarding health benefits and deductions.

● Explained benefits to plan participants in easy-to-understand terms

● Updated Insurance Plans and individuals; demographics and refiled claims

● Communicated with insurance providers to resolve any denied claims

● Review EOBs and Remittance to determine whether insurance paid claims according to members benefits

. ● Appealed member claims. Followed up on claims rejected. PATIENT SERVICE SPECIALIST I CLAIM CARE INC IN CARROLLTON, TX 11/2010 - 05/2018

● Assisted patients with questions regarding claims or scheduling

● Obtaining referrals and prior authorizations as required for procedures and medications.

● Verified patient insurance eligibility through BCBS Availity, Novitas, UHC, TMH

● Inbound/ outbound calls to patients; insurances; providers offices.

● Knowledgeable in Medicare Claims process, post of adjustments, A/R hospital accounts,

● Understanding and knowledgeable in Medicaid, Commercial Insurance (All payers),

● Calling insurance companies regarding any discrepancy in payments if necessary

● Identifying and billing secondary or tertiary insurances

● Updated patient demographics in Centricity, Medical Manager, ECW, Escripts, Ggastro

● Setup payment arrangements with patients

● Posted payments and denials on Centricity, ECW, Medical Manager, Escripts, PrognoCis,

● Worked with clearinghouse Emdeon, Centricity, EDI, Gateway, RealMed, Availity, NHS Net EDUCATION Grantham University, Arkansas, AR –

AAS Medical Coding and Billing 09/2021 - 07/2023

Certified Medical Coding and Billing – 09/2021

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