Medical Billing Third Party

Professional Summary:

Sylvia is a bilingual Medical Billing professional with nearly 30 years of experience within the healthcare industry, most of which stems from Revenue Cycle Management. During her time with UT Southwestern Medical Center, Sylvia gained experience on both the front and back end of the billing cycle while working with government and commercial insurance companies. Experienced with UB-04 and HCFA 1500 forms, Sylvia reviewed and processed claims to reconcile and resolve any payment discrepancies. In addition, Sylvia has experience following up and researching denied claims while acting as a liaison between clinical departments and, Third Party payers. Sylvia has worked exclusively with Epic in addition to 10-key, IDX, FileNet,

Navinet and Availity to ensure electronic reports were accurate. Lastly, Sylvia has a strong understanding of managed care contracts, contract language and medical terminology making her a well-rounded Medical Billing Specialist.

Professional Experience:

Huron Consulting April 2019 – December 2023 Insurance Verification Specialist

Verifies insurance policy benefit information and obtains Authorization/Precertification/follow-up/ RTE verify benefit’s OON/In Network/CTP Codes /Bilingual/Spanish/Data Entry/EPIC

Baylor Scott and White Hospital December 2018 April 2019 Insurance Verification Specialist

Verifies insurance policy benefit information and obtains Authorization/ Precertification.

US Anesthesia Partner September 2016-July 2018 Charge Entry Specialist

Charge Entry input demographic on MD Cloud and TES Edits.

UT Southwestern Medical Center-Dallas, TX** Retire

January 1987 – February 2015

Claims Analyst/Medical Collector I

September 2007 – February 2015

Researched, analyzed and resolved outstanding insurance claim in a timely manner

Efficiently navigated through the various screens in EPIC

Worked with UB-04 and 1500 forms

Reviewed and processed insurance claims through the billing system, including Medicaid, Medicare, third party payers

Contacted patients, and/or, third party payers to resolve outstanding insurance balances or inappropriately paid claims

Identified problems and inconsistencies by using management reports

Summarized findings and makes recommendations to resolve billing issues

Reviewed and resolved correspondence from all organizations

Functioned as a resource person for departmental personnel to answer questions and assists with problem resolution

Acted as a liaison between clinical departments and, third party payers

Completed special projects as requested

Duties performed included one or more of the following core functions: a) Directly interacting with or caring for patients; b) Directly interacted with or caring for human-subjects research participants; c) Regularly maintained, modified, released patient records (including patient financial records)

Claims Analyst/Billing

September 1997 – August 2007

Made sure all electronic reports were accurate, 10-key, IDX and FileNet

Billed Secondary Insurance Payer’s

Interpreted explanation of benefits

Worked with UB-04 and 1500 forms

Accessed IDX and FileNet to retrieve explanation of benefits and attached to claims and mailed

Processed complete and accurate primary and secondary claims daily.

Resolved system edits and claims errors in a timely manner.

Provided subject matter expertise to HIM, Collections, and Operation areas.

Communicated educational information as needed upon 3rd party payer changes which impact billing and/or reimbursement

Informed Managers of all edits pertaining to hard coded revenue areas

Kept upper management informed of system delays or issues that would delay or prevent daily billing activity

Performed reconciliation of claims dropping into claims editor

Participated in educating departmental staff of billing changes pertinent to the success of the department

Utilized system tools and department resources to achieve production and quality targets for resolution of patient accounts

Investigated and responded to questions or requests for additional information in a timely and professional manner to ensure proper, timely, and accurate payment of patient accounts.

Attended in-services, classes and meetings related to all operations to the PFS department

Understood reimbursement of all 3rd party payers.

Performed other duties as required

Office Assistant II

October 1987 – August 1996

Provided Customer Service

Helped with Spanish call when needed

Worked with Correspondence

Updated addresses and files

Assisted with anything office duty related

Education:

High School Diploma, Gladys Porter High School, Brownsville, TX

Texas Southmost College, Brownsville, Tx

Microsoft Office, Richland College, Dallas, Tx

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