Director of Reimbursement
Resume:
Loretta Molina
Redlands, CA 92374
Telephone: 909-***-****
*************@*******.***
Objective: To work in an atmosphere that will permit me to utilize my leadership skills and allow me to develop new skills.
Experience:
01/2016 – 06/12/2020 BMR Partners
Director of Reimbursement
Director of Reimbursement Department operations
Maintaining current knowledge of Medicare and Medicaid regulations to ensure reimbursement when clearing orders and obtaining authorizations
Completes all billing and follow-up functions timely and accurately of paper and electronic claims, including resolution of any billing errors
Ensuring that patient accounts are properly and completely documented with insurance information and all other pertinent information
Established and maintains online resources used in handling benefits, authorizations and claim process
Claims re-submission and/or escalation
Support to Reimbursement / Pharmacy staff directly related to intake clearance, billing, collection and authorization procedures.
Cash posting / applying payments to Medicare and Medi-Cal, review EOMB’s and Remittance Advice to assure correct payment received and applied to patient account.
Maintaining Payer set up, updating patient demographics.
Provided customer service to payers, sales team and upper management.
Experience:
07/14 – 01/2016 Fidelis Specialty Pharmacy, Arcadia CA
Lead Reimbursement Specialist
Actively participates and contributes to Reimbursement Department operations
Maintaining current knowledge of Medicare and Medicaid regulations to ensure reimbursement when clearing orders and obtaining authorizations
Completes all billing and follow-up functions timely and accurately of paper and electronic claims, including resolution of any billing errors
Ensuring that patient accounts are properly and completely documented with insurance information and all other pertinent information
Established and maintains online resources used in handling benefits, authorizations and claim process
Claims re-submission and/or escalation
Support to Reimbursement / Pharmacy staff directly related to intake clearance, billing, collection and authorization procedures.
Cash posting / applying payments to Medicare and Medi-Cal, review EOMB’s and Remittance Advice to assure correct payment received and applied to patient account.
Maintaining Payer set up, updating patient demographics.
11/06-02/13 National Cornerstone Healthcare Services, Loma Linda, CA
Supervisor
Completes all billing and follow-up functions timely and accurately of paper and electronic claims, including resolution of any billing errors
Claims re-submission and/or escalation
Ensuring that patient accounts are properly and completely documented with insurance information and all other pertinent information
Ensuring that all appeals processes are followed when insurance sources do not pay properly
Maintaining current knowledge of Medicare and Medicaid regulations to ensure reimbursement when clearing orders and obtaining authorizations
Established and maintains online resources used in handling benefits, authorizations and claim process
Actively participates and contributes to Reimbursement Department operations
Support to Reimbursement staff directly related to billing, collection and authorization procedures.
12/03-11/06 Curative Pharmacy Services, Corona, CA
Insurance Biller-Pharmaceutical
Streamlined & Structured billing process to ensure timely & accurate reimbursement from Insurance Payers
Medical records documentation and interpretation
Data Entry. Knowledge and application of CPT Codes
Claims adjudication
Reconciliation of claim payments as well as claim review and appeals
On-line submission of high dollar claims for immediate reimbursement
11/99 -12/03 Caremark Therapeutic Services, Redlands, CA
Senior Biller
Medical records documentation and interpretation
Billing of all Biotech medications including knowledge and application of CPT codes
Support to Collectors directly related to billing procedures
Coordinated billing processes; tracking, coding and preparation of billing packets
Ensured timely and accurate billing of codes and medication to ensure highest reimbursement
Clerical support; tracking, coding and disbursement of correspondence
08/97 -11/99 Beaver Medical Clinic, Redlands, CA
Appointment Clerk/Clerical
Medical records documentation and interpretation.
Manage large volume of calls, including hearing impaired, in fast paced environment.
Schedule appointments. Patient, Physician and Provider relations
Training new employees.
Create, update and verify patient accounts.
Education:
1982 Redlands Senior High School, Redlands, CA
Diploma
1983 Financial Training Academy, Grand Terrace CA
1990 Medical Office Assistance Certification, Redlands Adult Ed
Skills:
• Working knowledge of the insurance industry and medical terminology
• Knowledge of Medicare, Medicaid, Government, Managed Care, Private Insurance, and process and requirements
• Proven problem-solving skills and communication skills
• Excellent customer service and telephone etiquette skills
• Ability to navigate specific billing software
• Proficient in Microsoft (i.e. Outlook, Word, Excel, etc.).
• Self-motivated and able to work independently
Medical Software Systems: CPR+, Synergy, Macola, Medik, On Base, Medical Manager, and Manage Med, Reflections for Unix (CATS), CE2000
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