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Medical Manager Customer Service

Location:
El Paso, TX
Posted:
April 27, 2022

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Resume:

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

Santa Teresa NM *****

PHONE 915-***-****

E-MAIL

adqwg7@r.postjobfree.com

Linda Michelle Hernandez

Objective

To attain a position that will allow me to utilize my full business and professional medical experience and knowledge to its full capacity.

Summary of qualifications

Bilingual-ability to read, write and speak fluently in English and Spanish

Microsoft Word, Microsoft Works, Windows, Excel

Proficiency with office equipment to include multi-line phone, fax, 10 key, copier

Medical Terminology

ICD-9 Coding

Medical Manager

Invision

Meditech

Athena

Electronic Billing of Medical Claims

Data Entry of Claims with Medicare FSS system

Collections activity

Financial review and counseling to include patient surgical estimates and payment arrangements

Monthly financial reporting

Supervising

Customer service

Education

1989-1993 Bachelors Degree of Business Administration, Management

New Mexico State University

Professional experience

09/2020-current

Physician Business Manager; Wellmed (Optum)

Providing provider relations to contracted and affiliated providers

Assist in contracting issues

Claims reviews

Assist in completing quality measures

08/2018-07/2020

Practice Manager; Providence Medical Partners

Supervised registration and medical staff for a multispecialty clinic. Produced financial reports for monthly clinic reporting to administrators. Reviewed and maintained monthly budgets. Reviewed and assisted in maintaining KPIs (Key Productivity Indicators) at a standard measure as required of our clinics. Reviewed accounts with incorrect insurance payments for possible insurance reprocessing or appeals needed. Maintained exceptional customer service for both internal and external customers. Managed provider credentialing status with insurance payers remain active. Managed provider expense reporting and reimbursements processing. All other duties as assigned.

04/2009- 05/17/2018

Pre-Certification Specialist; El Paso Specialty Hospital

Assisted in managerial duties with financial reporting of Revenue cycle and Business Office practices, Assisted in handling patient complaints to ensure proper customer service, Assisted in overseeing 5-7 Registration department staff; reviewed daily surgery schedules to ensure adequate authorizations were in place for proper reimbursement, Compared and reviewed reimbursements with hospital payer contracts, reviewed and attained necessary authorizations/notifications for inpatient and outpatient procedures scheduled, Assisted in necessary appeals and collection follow up on accounts, Calculated patient financial estimates of responsibility based on insurance contracts and insurance benefits verified, Contact patients and assist with financial payment arrangements. Handled third party liability accounts with attorney offices through letters of protection, Direct communication and work with CEO and CFO with any issues at hand and any other duties as assigned.

04/2002 –04/2009

Patient Account Representative; Patient Financial Services, University Medical Center

Management of clinic and hospital accounts with commercial, worker’s compensation and managed care plans. Ensuring prompt reconciliation of accounts with insurance payments. Conducting necessary appeals either by phone or paper for timely reconsideration of denied claims. Reviewing account information to include registrations and insurance plans to assist in denials of claims on accounts. Electronic billing of medical claims both professional and technical. Other Duties as assigned

11/1998-04/2002

Office Manager; La Clinica De Familia Inc.

Supervised 7-8 employees per site, posted charges into patient’s accounts for billing department to generate claims, provided monthly reports to administration on the productivity output of the medical site, handled patient complaints, medical records management, conducted peer audit on proper functionalization of the clinic site, worked on the collection of both current and past due accounts, scheduled appointments of both in-house and outbound referrals.

References

James Wilcox 909-***-****

CEO; Legent Hospital – CEO at previous employer

Sylvia Gallardo 915-***-****

Market Decision Support Analyst; THOP East Campus – Previous supervisor

Emilia Avila 915-***-****

Retiree Coordinator; City of El Paso – Previous Coworker-Friend

Michelle Lorilla 915-***-****

Lien Specialist; UMC El Paso – Previous Coworker-Friend

Rocio Medrano 915-***-****

Student support staff; SISD – Previous Coworker-Friend



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