Skill Sets

Multi-Specialty Multi Carrier HMO/ PPO Workers Compensation Medicare/Medi-Cal

HIPPA CPT & ICD9/10 EOB’s Patient Registration Accounts Receivable

Collections Ins Verification Eligibility Account Resolution Authorizations

Professional Experience

CHMB- San Diego, CA 3/2017 to 4/2019

Medical Billing Specialist

Prepared, review and transmit claims using billing software, including electronic and paper claims processing.

Followed up on unpaid claims within standard billing cycle time frame.

Checked insurance payments for accuracy and compliance with contract discount.

Contacted insurance companies regarding any discrepancies in payments.

Identified and billed secondary or tertiary payers.

Researched and appealed denied claims.

Eligibility and benefits verification.

Verified if required referrals were obtained.

Researched and processed refund request.

Millennium Health - San Diego, CA 6/2014 to 3/2016

Claims Resolutions Specialist II Liability

Evaluated patient accounts for existing insurance coverage.

Researched claim denials for resubmittal or filing of an appeal.

Initiated and maintained proper follow up to ensure timely filing of claims and appeals.

Verified fee schedules from various payers.

Verified patient eligibility through various payer portals.

Sequenom Center for Molecular Medicine – San Diego, CA 7/2013 to 3/2014

Medical Billing Specialist

Verified insurance for all carriers.

Investigated denied claims for denial reasons.

Filed 1st and/or 2nd level appeals.

Verified the correct procedure codes were billed.

Sharp Healthcare - San Diego, CA 11/2011 to 12/2012

Medical Claims Processor

Entered and processed HMO and commercial insurance plans.

Verified that needed authorizations were on file and eligibility was current.

Assigned and sequenced appropriate diagnostic procedure codes in compliance with third party payer requirements.

Processed up to 250 claims per day.

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