ENID MERCADO

**** **** ******** ******, **** #* Vineland, NJ 08361 856-***-**** Email: adqtjq@r.postjobfree.com

SKILLS

•Able to adapt to constant changes and manage multiple tasks while prioritizing responsibilities.

•Proficient in Microsoft Word, Excel; WordPerfect and Power Point, Google Sheets

•Outstanding customer service and organization abilities.

•Fluent in Spanish with verbal and written translation capability.

•Certified Medical billing and coding.

•Qualified in the management of Electronic Medical Records.

•Proficient in Electronic Clinical Works, Mysis, AthenaNet, Intergy (Greenway)

•Experienced in all facets of administrative functions.

•Knowledge of Medical Terminology and Interpreting Medical Reports, ICD 9 and ICD 10, HCPCS

•Proficient in Pre-Certification and Pre-Authorization process for medical treatment

•Proficient in Cerner Sorian Financials, Cerner Sorian Clinicals, Revenue Manager and Cerner processes

•Proficient in reviewing statements prior to sending out to patients.

•Knowledge and understanding the importance of the HIPPA state regulations procedures and policy guidelines.

EXPERIENCE

EXCELCARE ALLIANCE, LLC~Vineland, New Jersey 2017-Present

ACCOUNTS RECEIVABLE, Health Insurance

•Accounts Receivable for all insurance carriers: call carriers for status of payments

•Appeal denied claims

•Work denials to a successful resolution which results in revenue for the practices.

•Assist patients with payments being collected on balances owed.

•Retreiving all medical reports from Hospital for all inpatient admissions, which include admission, progress notes and discharge summaries.

•Answer phone calls and interact with patients to assist them with payment options and processes.

•Collect payments and post to patient accounts, which include cash and credit card payments.

•Assist Spanish speaking patients with the billing and payment process.

•Verifying insurance eligibility for patients on the dates of service through Navinet.

•Charge Entry -for mutilpe physicians that conduct inpatient rounds at various facilities and place of service such as: Inpatient/Outpatient Hospital (Observation Admission), Rehabilitation, Nursing Home, Behavioral Mental Health, Skilled Nursing Facilities

•Utilizing various payor website portals to obtain Explanation of benefits for the purpose of payment posting.

•Assisting co-workers with Insurance processes.

INSPIRA MEDICAL GROUP~Glassboro, New Jersey 2016-2017

ACCOUNTS RECEIVABLE, Health Insurance

•Accounts Receivable for all insurance carriers; call carriers for status of payments

•Appeal denied claims

•Assist patients with payments being collected on balances owed.

•Assisting and educating managers, office staff and physician practices with the billing processes.

•Retrieving all medical reports and operative notes to support the medical necessity for treatment that was rendered to the patients.

•Answer phone calls and interact with patients to assist them with payment options and processes.

•Training co-workers with the statement process and the Medicaid recovery process.

•Assist Spanish speaking patients with the billing and payment processes.

•Educating patients on eligibility and benefit coverages on their health insurance plans.

•Verifying insurance eligibility for patients on the dates of service through Navinet.

PREMIER ORTHOPAEDIC ASSOCIATES Elmer, New Jersey 2015-2016

ACCOUNTS RECEIVABLE, Health Insurance, Automobile Insurance, Workers Compensation

•Accounts Receivable from all insurance carriers; call carriers for status of payments

•Appeal denied claims

•Post payments on patient accounts

•Handle all the receivables for the physical Therapy treatments from all insurances; Private health insurance, no-fault and workers compensation,

•Assist patients with payment plans and promise of payments.

•Assist patients in understanding payment processes

•Interpreter for all Spanish patients to assist physicians with the patients care

•Answer phone calls and interact with patients with the payment options and billing questions

•Support for the front desk, schedulers and physicians with any billing questions or issues

•Call insurance carriers repricing companies regarding negotiated contracted rates for Workers Compensation and Motor Vehicle Accident claims.

ADREIMA Bloomfield, New Jersey 2013-2015

ELIGIBILITY SPECIALIST, Medicaid Coverage

•Interviewing patients at bedside to determine eligibility for any state, federal or county programs for medical coverage.

•Completion of Medicaid applications online for the patients.

•Assisting patients in completing state documents for the completion of the Medicaid process.

•Evaluating diagnosis to determine the patient’s permanency of disability and having treating physician complete the necessary documents to assist the patient in the beginning process for social security.

•Documenting all interviews with the patients in hospital database as well as Adreima’s database.

•Maintaining queues and update patient’s files daily.

•Assisting patients with questions by way of phone, in person or at bedside.

•Assisting patient in gathering all the documents that are needed for the completion of the Medicaid process to forward to the County Board of Social Services or the state of New Jersey.

NEW JERSEY MANUFACTURERS INSURANCE COMPANY West Trenton, New Jersey 2000-2012

SUPERVISOR, Automobile Medical Claims

•Oversee all customer complaints and legal proceedings.

•Performed annual evaluations and established effective goals with each employee.

•Lead monthly staff meetings and conducted training sessions.

•Audited claims and concluded quality control.

•Responsible for contentions for arbitration on each personal injury claim.

•Decrypted medical requirements for precertification.

•Reviewed documentation to support medical procedure.

•Arbitrated bill procedures that included specific coding (ICD 9).

•Produced various correspondences to clients, claimants, attorneys’ and providers.

EDUCATION

MEDICAL CONSULTANTS INSTRUCTIONAL TRAINING CENTER (MCITC) Millville, NJ

•2013 Certified, Medical Billing and Coding Specialist

•2013 Certified, Medical Administrative Assistant/Electronic Health Records

VINELAND HIGH SCHOOL Vineland, NJ

•Alumni, 1988

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