Medical Collector Data Entry

JACQUELINE SANCHEZ

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

San Bernardino, CA 92410

Cell: 909-***-****

Email: adqcn4@r.postjobfree.com

Skills:

●Type 65 wpm, Bilingual – Spanish speak, write and read.

●Experienced in Internet, Windows, MS Word, Excel, Outlook, Access, PowerPoint, Word Processing, Mac, Lotus 123, data entry, PACS, Laser Arc, SMS/AS400 (Siemens), Cirius, DDE, Claims Administrator, MDX, Epremis, Emdeon, EPIC, Relay and Meditech.

●EMD (PRD Enterprise Gateway software Sunrise Clinical Manager 5.5), AM (Access Manager), Compass (AR Aging Reporting system), AS400 (Siemens/SMS).

●Knowledge & experienced with HIPAA regulations, medical terminology, ICD-9, ICD-10, CPT 4 codes, Medi-Cal MC180 forms, medical claims auditing.

Employment History:

(Temp Assignment) Robert Half Temp Agency – Curative – 11/2021 – 12/2021 (1 mo)

Position: Sr. Revenue Cycle Specialist

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Billing, Collections and AR follow up

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Worked rejections, appeals & denials management

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Checking claim status, online and via telephone.

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Working patient emails by responding via email or phone Reprocessing of claims with corrections for maximum reimbursement

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Review and audit claims to ensure minimal discrepancies

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Insurances include HMO, PPO, Managed Care, Senior plans, Medicare and Medi-Cal, Medicaid insurance s across the U.S.

(Temp Assignment) Health Advocates Agency - San Bernardino County Sheriff’s Coroners

08/2021 – 11/2021

Position: Autopsy Assistant

Responsible for receiving and processing all bodies arriving at morgue

Pulling and verifying all decedents information & paperwork & NOK for release to mortuaries via CCMS & CCMS2 system

Processing of indigents decedent’s & do eternals

Safe guarding valuables and effects per office protocol

Assist pathologist in examining of bodies including opening and dissecting cadavers

Performing sewing of bodies technique, do a body examination prior to autopsies, X-rays, weighing organs and fingerprinting decedent via IBIS, mikrosil, latent 10-print or dehydration, tissue builder, degloving or boiling.

Preparing bodies for release and miscellaneous other duties including: photographing bodies, specimen, and cleanliness of autopsy

Evidence collection, processing and documentation

Used lift & forklift to pull bodies from catacombs

(Temp Assignment) Robert Half Temp Agency - White Memorial Hospital 01/2021 – 07/2021

Position: Medical Billing Collections Specialist

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Billing, Collections and AR follow up

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Worked rejections, appeals & denials management

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Checking claim status, online and via telephone

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Reprocessing of claims with corrections for maximum reimbursement

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Review and audit claims to ensure minimal discrepancies

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Insurances include HMO, PPO, Managed Care, Senior plans, Medicare and Medi-Cal, Medicaid insurance s across the U.S.

County of Riverside Medical Clinics 10/2019 – 06/2020

Position: Medical Collection Specialist

●Register patients, schedule appointments, charge & collect money on co-payments or self-pay

●Screen/interview patients for low income programs: Sliding fee program, Family Pact, CHDP, EWC & Presumptive eligibility

●Assist patients' in application process, collect their income & personal documents for approval determination according to guidelines

●Clerical duties, verifications, scanning personal documents and insurance cards into EPIC account

●Eligibility directions eligibility with insurance is and screen patients for low-income programs

●Assist patients with concerns and issue for resolution

●Access patients with billing issues and accounts

(Temp Assignment) Robert Half Temp Agency - Loma Linda Healthcare 07/2018-08/2018

Position: Medical Government Collector

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Billing/Collections hardcopy and electronically for Medi-Cal and Managed Care insurances

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Checking eligibility

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Checking claim status, online and via telephone

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Checking and confirming authorizations for services

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Reprocessing and appealing claims

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Medical claims auditing

(Temp Assignment) Account Temps - NAMM Optum part of UnitedHealthcare 08/2016 – 11/2016

Position: Medical Claims Processor

●Processed claims for to ensure accuracy according to correct payment scale and timing this to avoid penalties.

●Extensively audited medical claims for Medicare, Managed Care plans and commercial insurance to ensure all rules and regulations were followed.

●Examined for overpayments or underpaid claims.

●Examined claims for accuracy and valid authorizations for services rendered for time of service.

●Requested for authorizations to be corrected, approved or changed.

●Followed appropriate COB for correct payment, updated information and examined all attached documents.

●Prepared and processed claims manually and electronically.

●Denied and approved claim lines and requested special check run.

●Received acknowledgement for #1 Claims processor for the month with 99% accuracy.

(Temp Assignment) Ledgent Staffing - Redlands Community Hospital 05/2016 – 06/2016

Position: Medical Collector

●Outpatient and ER commercial PPO’s and HMO’s hardcopy and electronic claims re-billing and follow up underpayments and denials for correct reimbursement.

●Collections on primary, secondary, TPL and 3rd party, crossovers.

●Used Meditech system and ChartMaxx for EOB’s and medical records.

●Authorization request, ICD-10, appeals online and hardcopy.

●Claims processing, examined extensively and posted adjustments, write offs, worked rejected claims and denials.

●Telephoned providers as needed for reconciliation on claim issues, denial and appeal status for resolution.

(Temp Assignment) Temp Unlimited - Aurora Mental Health 11/2015 – 02/2016

Position: Government Biller/Collector

●Inpatient and outpatient hardcopy and electronic claims processing and extensive auditing claims for Medicare, Medicaid (out-of-state) mental health patients.

●In charge of 5 hospitals in the states of Texas, Nevada and Illinois.

●Examined claims on primary, secondary, TPL and 3rd party, crossover billing and collections.

●Used AIS system, denial tracker, Emdeon and Doc-Link.

●Authorization request, ICD-10, appeals online and hardcopy.

●Submitted adjustments, write offs, worked rejected claims and denials.

●Make calls to providers as needed for reconciliation on claim issues, denial and appeal status for resolution.

Presbyterian Intercommunity Hospital - PIH Health 10/2007 – 03/2015

Lead Patient Financial Service Representative – Medi-Cal/Managed Care Position: Medical Biller Collector

●Experienced in hospital electronic/hardcopy processing, billing and collection on inpatient/outpatient claims for: Medi-Cal, Family Pact, CCS, GHPP, Breast Cancer Early Detection Program (BCEDP), Presumptive Eligibility, HMO Managed Care, IPA’s, and Medicare, Medi-medi crossovers, IME’s, Out Of State Medicaid, Emergency/Restricted Medi-Cal, GHPP, secondaries and TPL.

●UB04, HIPPA Compliant, ICD-9, CPT4, modifiers, Medical Terminology, data entry, troubleshoot issues, knowledge of Medi-Cal rules and regulations, Sterilization (PM330)/hysterectomy consent forms, RAD’s (Remittance Advice Detail), EOBs (Explanation Of Benefits), ACN’s (Attachment Control Number) forms, Claims Administrator, DDE, Media Data Exchange (MDX), Epremis, Emdeon and Cirius.

●Proficient in eTAR’s, SAR’s, appeals, CIF’s, RTD’s, CSU (Correspondence Specialist Unit), requesting Medi-reservations, write off adjustments, transfer payments, resolve account balances, SOC obligations, request LSRS (lab services reservation). Knowledge of commercial HMO and PPO follow up, copay/deductibles and pt. responsibility.

●Interviewed and counseled financially to determine eligibility and/or for billing and collections of current and delinquent accounts for self-pay and insurance patients.

●Report and problem solve all staff issues not limited to trend of denials or billing claim edits to decrease denials and rejected claims and help increase staff productivity.

●Create billing/follow up protocols for the staff to adhere to and substituted as needed ● Interviewed and trained new/current staff and managed up to 15 employees.

●Monitor Key Performance Indicators of individual team members; supervise, coach and take necessary action to facilitate achievement of performance targets.

●Develop and update policies and procedures

●Monitor staff attendance

●Extensive auditing of claims for billing and collections errors and compliance issues to ensure CMS, state and federal guidelines for accuracy.

●Maintain up-to-date knowledge of federal and state laws, rules, and regulations related to patient account service activities.

●Experienced with managing a CBO (Centralized Billing Office) and assisted hands on in building up a previously outsourced hospital in all aspects to ensure success.

●Review refunds for appropriate timeliness.

●Supervise implementation of new client services to ensure smooth, timely, and effective processing of claims.

●Perform staff annual performance reviews and periodic corrective action function in a timely manner.

●Participate with the Senior PBS Director with human resources issues including hiring, firing, and evaluation of assigned team members.

●Assist in establishing performance standards, policies and procedures, and compliance with government regulations.

●Ensure procedures are followed by team members regarding the problem identification and resolution system for appropriate order of responsibility.

●Processing claims for IME’s & Medicare outpatients for surgeries/Physical Therapies/series accounts/Observations & secondaries.

●Use of PC Print and updated account information as needed for correct payer.

●Medi-Cal eligibility, CWF, Checked claim status through DDE.

●Knowledge in reviewing and reconciliation of A/R, processing adjustments/write offs, reviewing and following up on denials.

●Billed Medicare primary and secondary billing through electronic and paper submission ● Worked T status claims for follow up in DDE system through Emdeon ● Notified management on claim edits for corrections.

●Knowledge of 72 hour rule for billing.

County of Riverside Temporary Assignment Pool (TAP/MAP) 09/2006 - 03/2007

Government Insurance Billing Clerk

●Hospital and physician electronic/hardcopy claim processing, billing and extensively audited for inpatient/outpatient Medi-Cal, MISP, Family Pact, CCS, GHPP, Breast Cancer Early Detection Program (BCEDP) and Presumptive Eligibility.

●Knowledge of principles of computer control systems, HIPAA regulations, medical terminology, ICD-9, CPT 4 codes, UB04 forms, modern office equipment.

●Experience in late charge reports, eligibility, backlog reports, submit adjustments on accounts, audit accounts, read and interpret EOBs (explanation of benefits) and RA (remittance advice), CIF’s and follow-up.

●Established, maintained and evaluated necessary records, prepare reports, charts, correspondence, data entry, multi-task and filing.

●Operated SMS (Siemens), MDX systems, Windows 2000, MS Word, Excel, Outlook, Novell GroupWise email, ten key and internet.

Valley Health Systems 10/2000 - 07/2006

Patient Finance Service Representative (Medical Biller Collector)

●Hospital hardcopy/electronic Medi-Cal processing, billing and examined claims for inpatient/outpatient Medi-Cal, Breast Cancer Early Detection Program (BCEDP), Presumptive Eligibility, Medically Indigent Special Persons program (MISP), Family Pact, Cal Optima, GHPP, Medicare, crossovers, HMO’s/PPO’s secondary and third payer, physical therapy and mental health (psyche) therapy.

●Knowledge of principles of computer control systems, HIPAA regulations, medical terminology, ICD-9, CPT 4 codes, modern office equipment.

●Experience in late charge reports, backlog reports, submit adjustments on accounts, audit accounts, read and interpret EOBs (explanation of benefits) and RA (remittance advice), follow-up on claim/account status for billing, PM330 consent forms, payments, share of cost (SOC) clearance, denials and adjustments.

●Established, maintained and evaluated necessary records, prepare reports, charts, correspondence, data entry, multi-task and filing.

●Operated SMS (Siemens), Emdeon (Medi.com) systems, Windows 2000, MS Word, Excel, Outlook and

Internet.

●Eligibility for Managed care and Medi-Cal patients through point of service (POE) machine or internet.

●Interviewed and counseled financially to determine eligibility and/or for billing and collections of current and delinquent accounts.

●Conducts pre-screening and other interviews with applicants and clients to obtain personal, family and financial data required to determine eligibility for Medi-Cal and other government programs.

●Audited and investigated that all information for accuracy and ensure there are no discrepancies.

●Handling of money for self-pay accounts, co-pays, deductibles and SOC. ● Tar's for inpatient, physical therapy and mental health patients.

Education:

San Bernardino Valley College – 65 Units Accrued

09/2017-Current

AA Degrees: Pending 03/2022

Major: Criminal Justice, Psychology, Liberal Arts

Southwestern Vocational College

10/2011-3/2012

Course Certificate: Forensic Science Academy Course

Individual Certificates:

●Death Investigation – Coroner/Anthropology

●Ridgeology/Friction Skin Comparison

●Forensic Photography

●Basic Crime Scene Investigation

●Advanced Crime Scene Investigation

●Advanced Technology In C.S.I

●Fingerprint Classification/Pattern Identification/Sequencing (40 Hours)

●Report Writing/Laws Of Arrest Firearms Safety

●Firearms Safety & Awareness.

AAHAM (American Association of Healthcare Administrative Management)

Certified: CPAT (Certified Patient Account Technician) Certification

Bryman College

Certificate: Medical Office Management

Professional Technical Computer Center

Certificates: MS Office Word, Excel, Access & PowerPoint

Alhambra High School

Diploma: General Education

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