Credentialing Coordinator Medical Billing

Patricia S. Gonzalez

***** ** ** ******, *****, Florida 33183 786-***-**** **********************@*****.*** Profile

Corporate Trainer and Manager with 10 + years of providing effective performance to NOVA Southeastern University, OMS Associates PA and Tenet Healthcare Systems. Excellent communication skills in English and Spanish. Able to train staff in diverse environments. Highly effective interpersonal skills with management, clients and colleagues. Solution-oriented, “can do” attitude. Poised, tactful, diplomatic, and calm under pressure. Precise attention to detail. Proven ability to multi-task and prioritize. Committed to excellence, integrity and confidentiality.

Professional Experience

2015-Present Nova Southeastern University, Davie, Florida Patient Account Lead Representative

Train and provide support to the Department of Clinical Operations (DCO)

Developed training materials for onboarding and current employees

Actualized department’s Policy and Procedure Manuals when needed

Review claims for accuracy prior to billing for optimal reimbursement

Identify trend denials and clearing house rejections. Develop corrective measures.

Review patient visits to ensure correct CPT, HCPSII, ICD10 codes are documented accordingly for optimal payment for General Medicine, OB/GYN, Geriatrics, Pediatrics, Rehabilitation/Occupational, Speech Therapy, Neuroimmunology, Rheumatology, Dermatology, Nursing Home provider visitations /provide support to Dental and Optometry Clinics

Communicate with Providers providing them an alternative code according to the notes provided for the visit

Make necessary corrections to encounters upon Provider’s encounter correction

Assist Compliance Department with review of encounters meeting medical necessity in accordance with payer specifications

Liaison between Finance and Patient Financial Service (PFS)/preparing Compliance refunds

Liaison between PFS and Credentialing/providing Credentialing Department with pertinent information regarding payer loading issues affecting claim reimbursement 2005-2015 OMS Associates PA, Plantation, Florida Billing/Coding/Collections/Credentialing Coordinator

Prepare departmental manual including but not limited to front end assessments through finalizing payment entries through accounting assessments.

Handle irate patients in the lobby and on the phone

Code and bill patient medical and dental records

Post payments, enter adjustments, send patient statements, set up payment arrangements, bill secondary and tertiary insurances

Set and maintain departmental financial goals on a monthly basis

Ensure accounts are up to date

Develop and implement collection strategies

Increased monthly patient and insurance collections from 54% to 95%

Assist front end with appointments, check in patients, treatment plans

Credential doctors with all insurance carriers, negotiate fee schedules, maintain doctors’ credentials up to date

Liaison between Provider and Insurance carrier

Help with office marketing/other administrative duties as needed

Help immobilize patients while sedated

Handle insurance audits

2005-2013 Management Resources Institute, Miami Lakes, Florida Instructor /Coordinator

Train students in all aspects of Medical Billing and Coding, including but not limited to CMS/JCAHO/HIPPA/AHIMA/Medicare/HCPCS/DRG codes Laws and Regulation to comply with current Healthcare guidelines

Prepare Billing and Coding Instructional manual for students and instructors

Manage other instructors and ensure teaching material is up to date

Maintain student record accuracy.

Tutor students to prepare for the examination

2003-2005 Tenet Healthcare Systems-Regional Office, Miami, Florida Patient Access Regional Trainer

Met and exceeded all Facility frontline and financial training needs.

Trained Admissions staff in all aspects of registration, including but not limited to CMS/JCAHO/HIPPA Laws and Regulation to comply with Facility, Region and State Guidelines

Access possible training needs, then train staff on how to meet department, facility and corporate goals

Provided training for Customer Service, Company Financial Directives, Calculating Patient Liability, overcoming upfront collection obstacles, Forms, Software Platforms

Developed training materials and strategies in accordance with facility needs 1990-2003 Hialeah Hospital Tenet Healthcare Systems, Hialeah, Fl. Patient Access Supervisor

Maintained high level of professionalism and efficiency in a department of 45 employees

Obtained patient data elements and transposed the information the frontline and financial platform

Developed Patient Access Training materials for the facility

Actualized department’s Policy and Procedure Manual

Areas of knowledge included Admissions Department, Scheduling, Surgery, Rehabilitation Department, Outpatient Department, Insurance Verification, Quality Assurance, Maternity and the Emergency Room.

Organize work orders and dispatch phlebotomist for sample collections

Enter patient samples in the system and distribute to appropriate department

Place results in patient’s file

Education

1999 - 2000 Miami Dade Medical Campus

Earned an Associates in Science Degree in Radiology Sciences

Certification in Billing and Coding

2005 Management Resources Institute

Certification in Billing and Coding

CCA Certification

Additional Skills and Training

• Knowledgeable in MS Excel, Word, and PowerPoint.

• Speak, read and write in Spanish

• Work with OMS Vision an Oral Surgery platform

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