Medical Billing Claims
Resume:
C O N TACT
******.*********@*****.***
Pasadena, Texas 77504
phone
address
P R O F E S S I O N A L S U MMARY
Seasoned Medical Claims Analyst with a proven track record at 6 Degrees Health, adept in processing high volumes of claims with precision and maintaining under 2% error rate. Skilled in data analysis and audit
compliance, while exemplifying strong interpersonal skills and ethical conduct. Excelled in team collaboration, training, and mentoring, ensuring adherence to HIPAA regulations.
E D U C ATION
May 2020
HIM - Medical Billing and Coding in Medical billing and coding
San Jacinto Community College, Houston, TX
January 2012
B.S. Biology in Pre-health
University of Houston Clear Lake, US
January 2005
Associate's degree Mathematics
San Jacinto College-Central Campus, US
E X P E R I E N C E
December 2021 - Present
Medical Claims Analyst
6 Degrees Health, Remote, TX
May 2021 - December 2021
Temp Medical Billing Sales Coordinator
Healthcare Business Connection, US
Processed daily average of 90 claims for multiple
self funded health benefits plans (TPAs) with an
average error rate of less than 2%.
•
Conducted daily audits of high dollar claims per
American Medical Association and CMS coding and
billing guidelines. Checked claims for medically
appropriate diagnoses, procedure codes and DRG
values.
•
Communicated with clients and healthcare
providers regarding claim status, medical records
needed and appeals.
•
Managed short and long term manual claims
processing projects for multiple clients.
•
Maintained current knowledge of coding updates,
billing practices and government regulations
related to healthcare reimbursement systems.
•
Analyzed data from multiple sources to identify
trends or patterns related to claim processing
issues.
•
Identified discrepancies between submitted claims
and payer policies or guidelines.
•
Responded promptly to customer inquiries
regarding claim status or payment resolution.
•
Evaluated patient medical reports to determine
necessary paperwork and subsequent steps for
claims.
•
Approved or denied claims requests through
collaboration with insurance agents and medical
offices.
•
Trained two staff in A/R management and
insurance verification
•
Billed out 800 claims per month to different
insurance payers (Medicare, Medicaid, Commercial
payers etc.)
•
S A N D R A N AVARRO
January 2020 - May 2021
Assistant Behavioral Health Billing Manager
Texas Behavioral Health - Friendswood, TX, US
December 2017 - December 2020
Billing and Insurance Coordinator
Gulf Coast Endodontics, US
Consolidated financial A/R report for clients based on their preferences
•
Cold called local medical practices needing medical billing and staffing needs
•
Assisted in credentialing new and existing medical practices or individual providers
•
Attended local networking events in order to gain
new clients.
•
• Team lead over 3 mental health billing specialists Weekly average Claim submission: 1,500 for a
group practice of about 20 mental health providers
•
Additionally billed for an individual
outpatient/inpatient provider
•
Averaged 100 outpatient claims per month and 900
inpatient claims per month
•
Worked with AR and Insurance Verification team
leads to decrease claim denial and rejection rates
•
• Yearly denial and rejection rates maintained at 2% Sent reports for providers to educate about
documentation and coding compliance issues
•
Prepared and sent medical records to insurance
companies and attorney offices
•
Assisted billing department supervisor in other
projects like provider credentialing and managed
general workflow of the department.
•
Billing: submitting average of 300 dental claims for the company's four offices per week
•
Following up with claims submission/denials
consistently keeping only previous three months in claims open pending insurance payments/appeals
determination etc
•
Insurance: Verifying insurance to obtain general
breakdown, coverage, deductible and waiting
periods for patients' dental insurance policies
(various PPO and DMO policies) for four separate
offices
•
• Estimate of about 300 patients per week
Payments: Posting payments from insurance
carriers to patient accounts, billing patients for overdue balances and depositing checks/issuing
reimbursements by check through Quickbooks
•
August 2016 - December 2017
Office Manager/Registered Dental Assistant
Red Bluff Dental, US
November 2015 - June 2016
Technical Project Assistant
PinnacleART, US
May 2015 - August 2015
Full Time Lab Technician
Aqua Solutions, Inc., US
Generating Collections and Production report for
four locations (about 6 providers) in
weekly/monthly report to billing department
manager
•
• (Endovision is the software used by the practice) Front Office duties: Dentrix software use in billing, coding, electronic patient chart auditing and
generating treatment plans for patients with same
day treatment
•
Office Manager duties: Entering Explanation of
Benefits (EOBs) in patient financial ledgers,
submitting Pre-Authorization narratives for dental treatment
•
Resolving overall issues concerning dental claims
with both PPO insurance and Medicare/Medicaid
plans
•
• CPR certified
• RDA license #96686 Active 07/12/2017-07/31/2018
Exceeded renaming production goal by 250% (up
from 200 to 500 documents daily) on 3 different
projects
•
Managed and delegated small team projects to
increase project productivity in datamining and
renaming of confidential refinery and processing
facility documentation
•
Trained new members in use of AutoCAD drafting
software, circuitization, renaming and Excel pivot tables
•
Accumulated project totals: 98% average quality
scores for completed projects and 100% deadlines
met
•
Met production standards by 100% by producing a
daily average of 10 high quality solutions/blends in a chemical lab that met industry standards and
customer specific requirements
•
Ordered and maintained lab inventory supplies for
quality assurance supplies and safety equipment
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L A N G UAGES
Spanish
Bilingual
•
English
Bilingual
•
S K I L L S
• Interpersonal Skills
• Training and Mentoring
• HIPAA Compliance Understanding
• Multitasking Capabilities
• Time Management
• Critical Thinking
• Ethical Conduct
• Research and Investigation
• Team Collaboration
• Medical Terminology Familiarity
• Attention to Detail
C E R T I F I C ATIONS
• Certified Professional Coder
C O N T I N U I N G E D U C ATION
PROFESSIONAL Medical CODING and billing Online Course, True, AHIMA Professional Medical Coding and Billing Program, ICD-10-PCS, ICD-10-CM, CPT, HCPCS, 08/2020, Certified Professional Billing Certification, 2022
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