Loretta Molina

*** *. ******* ***.

Redlands, CA 92374

Telephone: 909-***-****

adfoif@r.postjobfree.com

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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