EXPERIENCE MEDNAX, Inc. PEDIATRIX/OBSTETRIX MEDICAL GROUP, Orange, CA

HIGHLIGHTS Reconciliation Specialist October 16, 2016 - Current 2021

Primary person responsible for ensuring reconciliation of payment batches when an offset/recoup is part of the batch, claim

adjustments such as claims reprocessed and additional or deduction of payment (s), future recoupments (D57), Appeals to HMS when

a recoup/refund is part of the MEDI-CAL payment batch and NON-POSTABLES that are part of a batch-may need to be excluded

from the entire batch due to varies reasons (ex: state regulations (prop 56), state reductions or increases per billing guidelines by payer,

timely filing, paid or reduced. Additionally, responsible for assisting posters with balancing batches when there out of balance for

posting or system errors and any unforeseen issues that arise to cause the batch to be out of balance. Reviewing and identifying

correspondence pertaining to payer negative remits (EOB/EOP without a check number), payer advising current/future recoup (DS7).

All above pertains to managed care, commercial and government payers.

Customer Service Coordinator October 11, 2010 — October 16, 2016

Primary person responsible for escalated calls, patient disputes, bankruptcies, charities, and adoptions.

Research issues and performs collections efforts on outstanding accounts including telephone contact with responsible

parties and payers. Effectively resolves open items by negotiating settlements, submitting adjustments, providing

additional information, etc. Achieves the highest level of customer satisfaction in the performance of all duties. Takes

appropriate actions within 72 hours of placement or as specified in the policies and procedures.

Job Responsibilities/Duties:

© Makes the necessary telephone or written contact on all accounts and tasks assigned to the CSC through queue transfer, account/encounter tasking, or

internal call escalation. Contacts payers to verify accuracy of reimbursement. Sends appropriate letters within required time frames. Conducts

negotiations for settlement of personal balances per the payment options.

© Reviews and works all accounts/encounters within 72 hours of placement. Consistently follows up on open issues to ensure they are resolved as soon

as possible.

© Reviews, assesses and follows up on accounts/encounters in accordance with the policies and procedures with following Adoptions, Bankruptcy,

Patient Disputes, Charity, Secure Communications/PHI, Confidentiality/Shredding.

Correctly updates the billing systems with information obtained from call center and or patients. Elevates unresolved issues to appropriate manager,

acts as a liaison between call centers, collections and accounts receivable departments.

Provides training when requested by manager. Troubleshoots issues with limited directions from others.

* Communicates effectively with telephone, email, fax and memos. Communicates well with the call center representatives to resolves patient issues

and is a continued resource in all areas related to policies and procedures.

® Promotes teamwork, understands the importance of working internal and external to the customer service department. Works well with others

including co-workers, willing to help other representatives.

© Functions independently, able to work daily tasks with limited direction from others. Presents a professional and positive attitude. Complies with

policies and procedures.

Tasks performed in: GPMS, OBR, EMDEON, IVR, Master Database, NEXTGEN, On Base, Excel and Word.

Underpayment / Overpayment Specialist September 10, 2004 - March 2010

. Audit patient accounts for underpayments made by the insurance payers and provide necessary documentation when appealing for the

additional amount.

© Review patient accounts for overpayments made by an insurance payers or patient and providing documentation for the refunds.

© Maintain a thorough knowledge and understanding of the payers’ contracts.

© Accurately manage, track and report the monthly results for underpayments that have been designated as true underpayments in addition to other

underpayment issues.

* Notify payers of any overpayment trends that may occur and to assist them in resolving the issue.

© Have provide support to the Office Base staff and Patient Account Staff regarding contract information issues or trends.

* Knowledge of GPMS and NextGen.

Collector Administrator November 1999 — September 2004

. Interaction with patients via telephone, verification of insurance eligibility, proper posting and billing of medical services and follow-up

collections (with insurance provider or patient).

® Ability to understand legal contracts regarding coverage and insurance payments.

© Make appeals to providers as needed, along with follow-up on appeal status.

* Meet the expected goals for collections and follow-up.

Apria Healthcare, Irvine, CA 1995-1999

Collector Administrator

© Interaction with patients via telephone, verification of insurance eligibility, proper posting and billing of medical services and follow-up collections

(with insurance provider or patient).

© Ability to understand legal contracts regarding coverage and insurance payments.

© Make appeals to providers as needed, along with follow-up on appeal status.

® Meet the expected goals for collections and follow-up.

Erma Gonzalez Placentia, CA. 92870 - Mobile 714-***-****

ado1jm@r.postjobfree.com

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