Detailed-oriented medical billing specialist with 7 plus years of experience managing

medical insurance claims, specializing in workman's compensation and auto accident claims. Highly motivated self-starter whose growing success has been attributed to excellent project management, communications, social networking, and event planning skills. Dedicated leader with a solid background in the beneficial use of new media opportunities, outreach strategies, website management, and fundraising approaches.

PROFILE

EDUCATION

ASHWORTH COLLEGE

Medical Billing and Coding

2018-Present

PHARMACY TECHNICIAN

Florida Institute of Technology

2016-16

COLLEGE DEGREE IN FASHION

MERCHANDISING/MARKETING & MANAGEMENT

Wood Tobe-Coburn College

2004-2005

HIGH SCHOOL DIPLOMA

Seward Park High

2000-2004

KEY SKILLS

Fredericksburg, VA 22406

845-***-****

adoeod@r.postjobfree.com

Project Management

Customer/Media Relations

Social Networking

Event Planning

Skillful Communications

Acute Detail Orientation

Organizational Effectiveness

Multicultural Awareness

Strong Community Focus

Fundraising / Negotiating

Leadership / Guidance

PROFESSIONAL EXPERIENCE

MEDICAL BILLING SPECIALIST

AUTOMATED HEALTHCARE SOLUTION, SUNRISE FL SEPT 2018-PRESENT Knowledge of accounts receivable, drafting appeal letter and calculating deductible. Complete and submit CMS-1500, DWC-10 and DWC- 66 forms. Excel in collecting reimbursement of insurance billing. Analyze and resolve unpaid claims and denials; providing insurance companies with additional documentations/records

(if requested) to expedite payment and resolve denials. Demonstrate expertise in identifying CPT and payer denial patterns, reducing denial rates by 15%. Identify and correct clerical errors. Train and lead other staff members. Correctly record and update patient and clients accounts.

R E B E C C A R I V E R A

Responsible for day to day supervision of Third Party Billing staff. Manage all accounts receivable from start to finish. Provide associate scheduling to ensure shift coverage, research and resolve escalated claim issues, and oversee employees Claims to Work performance including metrics and training. Provide scheduling to support operational hours and ensure complete billing coverage across multiple shifts. Generates standard reports for the functional area and tracks all employee performance for high volume transaction area. Oversees day to day employee metrics and Claims to Work performance. Audits claims to ensure effectiveness of financial controls. Provides research on accounts receivable/billing issues. Provides functional advice and training to team members as needed Effectively collaborates with internal and external business partners including Pharmacists and General Managers Other duties as deemed necessary BILLING ADJUDICATION SUPERVISOR

SENTRIX, POMPANO BEACH, FL JAN 2016-AUG 2018

MEDICAL BILLING SPECIALIST AND ADJUDICATION SUPERVISOR MEDICAL BILLING SPECIALIST AND ADJUDICATION SUPERVISOR COMPUTER SKILLS

ENGLISH: Native

SPANISH: Fluent

MS Office

Salesforce

Search engine optimization

Internet research

website management.

Micro Merchant

Quick Books

PROFESSIONAL EXPERIENCE (continued)

LEAD PHARMACY TECHNICIAN

CVS, NEW YORK, NY, SEPT 2009-AUG 2013

Monitor and prioritize workflow of pharmacy technicians, including billing activities. Prepare dosage medications for dispensing into bottles and unit dose packaging. Assist in preparing and dispensing medication under direct supervision of Pharmacist. LANGUAGES

REBECCA RIVERA

BILLING ADJUDICATION SUPERVISOR

HM PHARMACY, NEW YORK, NY OCT 2013- DEC 2015

Responsible for day to day supervision of Third Party Billing staff. Provide associate scheduling to ensure shift coverage, research and resolve escalated claim issues, and oversee employees Claims to Work performance including metrics and training. Provide scheduling to support operational hours and ensure complete billing coverage across multiple shifts. Generates standard reports for the functional area and tracks all employee performance for high volume transaction area. Oversees day to day employee metrics and Claims to Work performance. Identify and resolve issues of denials, prior authorizations and/ or follow up of claims . Audits claims to ensure effectiveness of financial controls. Provides research on accounts receivable/billing issues. Provides functional advice and training to team members as needed Effectively collaborates with internal and external business partners including Pharmacists and General Managers Other duties as deemed necessary

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