Collections Specialist Data Entry
Resume:
Raymond Nick
Sanchez
Medical Collections Specialist
rs
Professional Summary
I have been in medical billing and collections for 10+ years, familiar with PPO, HMO, commercial, OON
accounts, successfully negotiated with Multi-Plan, Zelis and Data Isight, the many years of experience has given me strong analytical skills enabling me to locate errors in the billing that would stop a claim from being processed or paid, I love what I do
Work History
2020-06 -
2024-03
Medical Collections Specialist
Avia Factoring, Toluca Lake, Ca
Conducted comprehensive audits of patient accounts periodically, identifying discrepancies requiring
correction or further investigation.
Monitored account receivables to identify trends and proactively address potential issues.
Enhanced revenue recovery through diligent follow-up on delinquent accounts.
Collaborated with insurance companies to expedite
claims processing and secure timely reimbursements. Updated patient records accurately to ensure seamless coordination between departments and minimize
delays in treatment or billing.
Maintained thorough knowledge of billing regulations, keeping the practice compliant with industry best
practices.
Reviewed aging reports regularly to prioritize collection efforts strategically based on account status and risk level.
Contact
Address
Sun Valley, CA 91352
Phone
***********@*****.***
WWW
https://bold.pro/my/raymond-
sanchez-240*********
/605r>Bold Profile
Managed high-volume caseloads effectively while
maintaining strong attention to detail and accuracy in data entry tasks related to billing adjustments or chargeoffs.
Processed online and paper appeal submissions and
refund requests.
Processed billing calls and answered questions from patients and third-party carriers.
Corrected, completed and processed claims for
multiple payer codes.
Researched billing errors and discrepancies to initiate corrective action.
2017-09 -
2020-03
Collection Customer Service
Representative
Team Health West, Chatsworth, CA
Monitored account receivables to identify trends and proactively address potential issues.
Enhanced revenue recovery through diligent follow-up on delinquent accounts.
Collaborated with insurance companies to expedite
claims processing and secure timely reimbursements. Updated patient records accurately to ensure seamless coordination between departments and minimize
delays in treatment or billing.
Maintained thorough knowledge of billing regulations, keeping the practice compliant with industry best
practices.
Reviewed aging reports regularly to prioritize collection efforts strategically based on account status and risk level.
Managed high-volume caseloads effectively while
maintaining strong attention to detail and accuracy in data entry tasks related to billing adjustments or chargeoffs.
Processed online and paper appeal submissions and
refund requests.
Corrected, completed and processed claims for
provider issues
Processed billing calls and answered questions from patients and third-party carriers.
Researched billing errors and discrepancies to initiate corrective action.
Entered client details and notes into system for
interdepartmental access and review.
2012-03 -
2017-07
Medical Collections Specialist
Complete Infusion Care, Los Angeles, CA
Managed high-volume caseloads effectively while
maintaining strong attention to detail and accuracy in data entry tasks related to billing adjustments or chargeoffs.
Worked closely with clinical staff to verify services rendered, enabling accurate coding and billing
procedures.
Maintained thorough knowledge of billing regulations, keeping the practice compliant with industry best
practices.
Conducted comprehensive audits of patient accounts periodically, identifying discrepancies requiring
corrections
Updated patient records accurately to ensure seamless coordination between departments and minimize
delays in treatment or billing.
Contributed to process improvements within the
department, resulting in enhanced workflow efficiency and better overall performance metrics.
Reviewed aging reports regularly to prioritize collection efforts strategically based on account status and risk level.
Enhanced revenue recovery through diligent follow-up on delinquent accounts.
Improved patient satisfaction by promptly addressing and resolving medical billing disputes.
Monitored account receivables to identify trends and proactively address potential issues.
Collaborated with insurance companies to expedite
claims processing and secure timely reimbursements. 2005-02 -
2012-02
Medical Billing / Collections
Tower Outpatient Surgery, Los Angeles, CA
Ensured compliance with industry regulations by
staying up-to-date on changes to medical billing
procedures and guidelines.
Posted and adjusted payments from insurance
companies.
Filed and updated patient information and medical
records.
Located errors and promptly refiled rejected claims. Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances
not covered under policies when applicable.
Liaised between patients, insurance companies, and billing office.
Monitored changes in payer requirements, adjusting billing practices accordingly to minimize disruptions in the revenue cycle.
Researched CPT and ICD-9 coding discrepancies for
compliance and reimbursement accuracy.
Ensured timely submission of claims to various
insurance carriers, resulting in prompt reimbursement Precisely completed appropriate claims paperwork,
documentation and system entry.
Efficiently processed refunds or adjustments for
patients when necessary, ensuring accuracy and
compliance with company policies.
Conducted regular audits of patient accounts for
potential underpayments or overpayments due to
incorrect coding or billing practices.
Analyzed complex Explanation of Benefits forms to
verify correct billing of insurance carriers.
Communicated with insurance providers to resolve
denied claims and resubmitted.
Maintained strong working relationships with
healthcare providers, fostering clear communication regarding billing-related matters.
Reduced errors in medical billing by meticulously
reviewing patient records and ensuring accurate
coding.
Collaborated closely with the clinical team to ensure proper documentation was obtained for accurate billing purposes.
Communicated with patients for unpaid claims for
HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
Collected payments and applied to patient accounts. Maintained and updated collections tracking
spreadsheet to help organize payment information.
Precisely evaluated and verified benefits and eligibility. Participated in departmental meetings, sharing insights and ideas for improving overall medical billing
efficiency and revenue generation.
Prepared billing correspondence and maintained
database to organize billing information.
Verified insurance of patients to determine eligibility. Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
Posted payments and collections on regular basis.
Delivered timely and accurate charge submissions.
Monitored outstanding invoices and performed
collections duties.
Reconciled accounts receivable to general ledger.
Responded to customer concerns and questions on
daily basis.
Education
1985-06 Diploma: Gen Studies
Garfield High School, Los Angeles - East Los Angeles
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