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
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