Brenda Jasmin Robles

***** ******* **

Lynwood, Ca 90262

323-***-****

admcqy@r.postjobfree.com

admcqy@r.postjobfree.com

Summary of Qualifications

Explanation of Benefits(EOB) CPT-4 AND ICD-10M Computer skills, appointment scheduling, daily use of electronic health record system. Knowledgeable of CCS, Medi-cal/ Medicare, HMO, PPO IPA and managed care billing practice. Medical Terminology, data entry, insurance reimbursement procedure and diagnostic coding. Workers Compensation claims, personal injury claims

Professional Experience

UCLA HEALTH September 2019- April 2021

Patient Biller III

Experience with online Accounts Receivable billing systems (Epic system and IDX)

Knowledge of UB04 and 1500 Billing form and electronic submission

Knowledge of Revenue Codes, Medical Terminology, CPT-4 ICD-10 CM coding and computerized billing systems

Reviewed patient accounts to ensure accuracy and completeness of claims billing maximum reimbursement.

Processed inpatient and outpatient claims to third party payers, following all mandated billing guidelines

Ensured Timely Filing guidelines are met, claim corrections appearing on edit reports, initiate appeals

Draft, compose, and submit appeal letters specific to coding issues consistent with the most updated American Medical Association Current Procedural Terminology

Knowledge with Medi-Cal, Medicare, HMO, private third party payors and Workers Compensation.

Evaluate accounts to determine any write-offs or corrections required, including duplicate charges.

Medical billing and collection experience in surgical divisions; Orthopedics and Family Practice.

Spectrum Business Class August 2015-July 2019

Sales Support Business Coordinator

Order entry relating to HSD and Phone Provisioning, Porting and Ancillary across multiple vendors and platforms including IP Static creation

Processed all order entry for new and existing business customers, migration of product while confirming services and installation date.

Knowledge of product information, packaging, pricing, current offers, and knowledge of all three lines of business (Cable, HSD, Telephone).

Schedule all Broadband, Commercial Cable and Voice Sales of upgrades, installs, special request into the CSG billing system.

Cross reference all Commercial Service Agreements with Salesforce database

California Choice Health Benefits (Contractor) May 2014-August 2015

Patient Benefits Phone Coordinator

Handled calls from customers to resolve, educate, follow-up, and respond to questions regarding California Choice Plan administration and procedures.

Answers questions by telephone (about 50 to 75 calls a day) from employers regarding new hires, billings, rates, supplies, administrative procedures, etc.

Educated via telephone, employees/dependents regarding PCP's ID cards, Rx problems, administrative procedures, dependent coverage, address changes, ect.

Mission Road Pharmacy Specialty (Contractor) February 2013-April 2014

Patient Care Pharmacy Coordinator

Patient prescription refill request, pre-authorization, and data entry notations.

Prescreen patient for co-pay assistance, payment options and or payment.

Scheduled timely delivery for all specialty medications.

Timely Reversal and or Credit due on RX

Sets up script, data entry and patient benefit eligibility verification

Coordination of financial arrangements and collection co-payments

Completes prior authorization requests, submits to insurance, and verifies completion

Answers patient inquiries about billing, procedures, policies and available services

USC+LACounty Hospital/ Keck of Medicine August 2010-December 2012

Medical Insurance Billing Clerk/ Hospital Representative

Medical Terminology, submission of Medical Claims, Managed Care, Insurance Reimbursement, and Diagnostic Coding.

Appeals with all necessary documentation (Medical Records, Confirmation number for patient treatment) needed and/or missing.

Timely controlled tasks of charge corrections/charge entry assuring and monitoring for receivable payments.

All phases of Collection Procedures, Insurance Carriers, including Tracing a Medical Claim, Appealing Low Payments, and Patient Accounts.

Accounts Receivable, Monthly Refund Report(Insurance/Patient) Compliance, Medical Records, Medical Biller.

SKILLS

Bilingual (English and Spanish)

Verification of insurance

Understand working in a team environment for the success of the team

Knowledge of Medical Manager, Meditech & Med-Soft windows X

Knowledge in HCFA 1500 forms

Microsoft Word, Outlook, Excel,

Professional Billing

45 WPM, 10 key by touch

Office Ally

Encoder Pro

NaviNet

Health Logics

Centricity (GECB)

ICD10 CPT

NCCI Edits

MUE (medically unlikely edits)

Modifiers

GE EDI

Power Chart (Cerner/Message Center

Medical Records Software

Appeals and Collections

Payment Insurance Billing Posting

End of month Reports

End of month Write offs

Education

Newbridge College Long Beach, Ca 2010

Medical Insurance Billing/ Coder, and Office Management

David Starr Jordan High School Los Angeles, Ca 2000

High School Diploma

These experiences have provided me the opportunity to make significant contributions in each job assignment I have completed. I am versatile, possess good commonsense, a true leader by example, works well with no supervision, excellent worker under extreme pressure, and I have gained the respect of those with whom I have come in contact.

Contact this candidate