Account Representative Call Center

MARIA SANDOVAL

Mercedes, TX *****

**********@***.***

T: 956-***-****

Billing & Coding Specialist- Certified

Experience as:

• Account Representative

• Claim Representative

• Claim Reimbursement Specialist/ Analyst

• Claim Insurance Specialist

• Grievance,Appeals, and Disputes

• CMS Guidelines

• State and Federal Regulations

• ICS & EDI

• Knowledge and understanding of CMS 1500, UB04, and EOB/RA

• Knowledge of CPT & HCPCS coding language preferred, ICD-9 & ICD-10 Understanding of insurance plans HMO’s, PPO, OPS and other Managed Care plan (supplement),Worker’s Compensation, & Auto Claims (PIP).

Call Center

• Facility

• HHA

• Institutional

Hobbies

Read Books

• Business

• Leadership

• Investment

Work Experience

Billing Clerk

APC Home Health Services Inc.-

Harlingen, TX

August 2021 to July 2023

Duties:

Supervise Claim Billing

Follow up Claims Payments Status

Keep Records of All of the Productively in Revenues

Process Contract Rate Reimbursement Appeals

Reimbursement Analyst

Prime Healthcare Services-

Harlingen, TX

October 2017 to April 2023

Researched rejections, investigating problems to appeal un paid claims.

Investigated and resolved billing issues to maximize cash flow and minimize liabilities. Completed in-depth analysis of business operations, trends and obligations to complete accurate projections.

Medical Office Specialist

Anabelle Lopez OBYGN-

Weslaco, TX

August 2015 to August 2017

Office Coordinator

Registration of New Patient

Charges for Services

Insurance Verification Procedure /Surgery Prior-Authorization

Review of Unpaid Claims, Daily outcalls to Patients for missing information (30 average), Scheduling and Reschedule Appointments.

Education

Some College Hours in Medical Administrative Assisting Technology

South Texas Vocational Technical Institute -

Weslaco, TX

February 2014 to March 2015

Skills

•

Strong Attention to Details

•

CPT Coding

•

ICD-9

•

Medical Billing

•

Managed Care

•

ICD-10

•

Medical Office Experience

•

Transcription

•

Workers' Compensation

•

Medical Coding

•

Accounts Receivable

•

EDI

•

ICD coding

Certifications and Licenses

125545

February 2015 to February 2024

NAHP

National Association for Health Professionals

RHIA

Medical Billing Certification

Contact this candidate