Susana Pena

**** *********** ***, *********, ** *3535 213-***-**** adrg2s@r.postjobfree.com

Objective

Motivated medical billing and collections specialist with over 16 years of experience in health operations management, billing, and collections. Expertise in ICD-9 and ICD-10, CPT, and HCPCS coding. Highly skilled in analyzing and validating patient information, diagnoses, and billing data. Demonstrated leadership skills that enable the processing of high volumes of patient information to achieve revenue generation goals, with most current experience in Home Health and willing to learn more.

Core Qualifications

ICD-9 and ICD-10 Coding

HMO's and Medicare

Operations Management

Quality Assurance and Auditing

CPT and HCPCS processing

Medical Billing

Medical Records Management

Patient Confidentiality

Experience

Aveanna Healthcare formerly known as Premier Healthcare, Palmdale, CA – Compliance/Service Coordinator

January 21st, 2019 - Current

Compliance coordinator/Branch Administrator/Client Service Coordinator for home health agency. Assist nurses with all the State requirements and regulations. Work hand in hand with the Client Service Coordinator to hire LVNs, HHAs and staff our patients. Assist nurses with Any documents that need to be signed. Have a file for each nurse and have it completed and ready for any audits. Verifies new employees’ credentials and runs appropriate background screenings, assist in answering a multi-line phone system, interacts and communicates effectively with colleagues and all levels of management within corporate and branch offices. Promoted to Client Service Coordinator, Recruiting Creates and responds immediately to daily e-mail alerts from Indeed, Zip Recruiter, Craigslist, CareerBuilder and other sources; contacts potential candidates via email, phone and/or texts same day, multiple attempts (morning, lunch, end of day) Schedules all qualified applicants for next available Assessment Center during first conversation with candidate when possible, staffing Works with field staff and families to accommodate the best staffing match for the client, scheduling Manages the staffing needs of the client as ordered by the physician, Builds strong relationships with families, staff and referral sources, Utilizes reports and collaborates with the Clinical Managers/Supervisors to ensure that field staff is appropriately credentialed. Actively recruit, post jobs, interview and staff nurse personnel. Perform background checks, verify Licenses, send new nurse applicants to partner clinic to get physical exams and TB test. Asses nurse experience and negotiate pay. Assign nurse shifts to patients. Manage and maintain nurse/patient schedules. Accompany the Homecare manager on sales/customer service calls. Provide exceptional customer service to staff and clients. Meet business goals and deadlines. Process payroll for nurses. Assist with payroll issues and payroll adjustments. Relieve nurses not adhering to procedures and regulations while on duty. Answer high volume of calls.

Sutherland Healthcare Solutions, Torrance, CA — Sr. Billing Specialist, Commercial Dept.

February 2012 – 08/27/2017

Collected, posted, and managed patient account payments, and prepared and submitted claims forms to insurance companies and other third-party payers. Performed insurance verification, pre-certification, and pre-authorization. Entered procedure and diagnosis codes, and requisite patient information into billing software to streamline invoicing and account management; added modifiers, verified diagnosis, and coded narrative diagnosis. Responded to staff and client inquiries regarding CPT and diagnosis codes.

Cymetrix, Gardena, CA — Commercial Biller

December 2009 - June 2011

Enter information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insure claim information is complete and accurate. Submit insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form. Answer patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolve patient complaints or explain why certain services are not covered. Follow HIPAA guidelines in handling patient information. Periodically create insurance or patient aging reports using the medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts. Understand managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties. Verify patient benefits eligibility and coverage. Ability to look up ICD 9 diagnosis and CPT treatment codes from online service or using traditional coding references.

Physicians Management Group, Brentwood, CA — A/R Collections Processing Associate

April 2007 - December 2009

Follow up with insurance company on unpaid or rejected claims. Resolve issue and re-submit claims. Prepare appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal. Prepare patient statements for charges not covered by insurance. Insure statements are mailed on a regular basis. Work with patients to establish payment plan for past due accounts in accordance with provider policies. Provide necessary information to collection agencies for delinquent or past due accounts. Post insurance and patient payments using medical claim billing software. Perform “soft” collections for patient past due accounts. This may include contacting and notifying patients via phone or mail. For patients with coverage by more than one insurer, prepare and submit secondary claims upon processing by primary insurer.

Education

HEALTH CLAIMS EXAMINER/BILLER 2005 AMERICAN CAREER COLLEGE

·Minor: Certificate

High School Diploma

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