Lorraine Holguin

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

Peoria, Az ***45

602-***-****

adrvd1@r.postjobfree.com

Objective:

Obtain a position with stability and opportunity for advancement. Employment:

PHI Air: Follow-up & Collections-Billing Specialist II 02/14/2019-02/17/2020 Patient advocate to obtain additional information and support for claims processing or to discuss outstanding patient balance with options available for balance resolution Assist with special projects related to payer issues or overall collections shortfalls maintain consistent customer focus in the face of adversity and change both internal and externa l

Demonstrate the ability to contact insurances in a consistent and knowledgeable manner in order to obtain timely payments, this includes escalation of issue to supervisors understanding of payer fee schedules, enrollment requirements along with PHI payer and facility contracts

performs an understanding of insurance collections to include; payment in full (negotiation) offers, overpayment reviews and approvals, next action on correspondence, insurance types, insurance classes, in compliance with PHI's billing policies and procedures Draft correspondence to patients and payers including 1st level appeals for technical denials, and identify accounts to refer to Appeals Department for escalation Handle patient calls in support of collections activities to include financial review for charity program, payment plans, negotiation of discounts and proper resolution of patient complaints Maintaining a professional relationship and effectively communicating with first responders, facilities, PHI agencies, entities, insurers, attorneys and patient's Must demonstrate positive teaming, effective cooperation in all communication within established team and throughout the entire PFS department Organize and prioritize work to support production goals utilizing on-line tools and required systems and software

Participate in increasing responsibility through ongoing training and expansion of duties Perform financial screening for payment in full (negotiation) offers, setting up payment plans and PHI's charity program in compliance with PHI's billing policies and procedures for appropriate next required action

Perform in-depth account review such as; skip tracing, correspondence research, secondary claims billing, payment review, contractual adjustments and modify insurances/demographic information in compliance with PHI's billing policies and procedures for appropriate next required action

Perform, identify, collect and confirm insurance coverage to include obtaining prior authorization, third party liability and coordinator of benefits

Possess a good working knowledge of HCPCS, CPT, ICD-9, ICD10 codes, medical terminology and clinical documentation

Review and evaluate any patient account for appropriate handling – regardless of age, status or payer

Review and interpret explanation of benefits to determine contractual compliance, accuracy of payment received, true patient responsibility, status of denied or reduction of service coverage and follow up appropriately

Understand billing requirements for all payers and participate in ensuring claims are accurate prior to submission; train staff on billing requirements for new and established payers Understand insurance regulations and guidelines to include CMS guidelines in order to effectively discuss outstanding claims with payers related to slow payments, underpayments, denials and to ensure claims are processed compliantly and paid appropriately Complying with Company HS&E policy and procedures

Responsible for supporting company Safety Management Systems activities Understand and provide visible support of Destination Zero Other duties and responsibilities as assigned

CVS/Coram Health: Account Receivable 08/23/2016-12/08/2016 Call Center environment. Data entry. Collected on home infusion account with insurance companies, submission of written appeal for payment, reviewed and follow-up on correspondence received. Worked special reports on high dollar, Answered incoming calls. Bureau of Medical Economics: Medical Collector 07/10/2012-06/13/2014 Call Center environment, review patients bills and call to collect on outstanding balances, data entry, contact attorney’s office if needed.

Catholic HealthCare West: AHCCCS Biller-Collector 03/05/2007-08/04/2011 Biller -data entry of patient demographics, follow-up of insurance eligibility for all insurance plans, charge entry of provider hospital charges, performing contractual adjustments of received payments, to include follow-up on underpaid claims, working monthly credit reports. Ahcccs Collector- submission of written appeals for payment, review and follow-up of correspondence received, review and follow-up on all outstanding, processing of refunds to various state agencies. To include high level of quality assurance in regards to account documentation of follow up on patients accounts including monthly quality assurance individual reviews. Experience with UB04 claim forms and 1500 claim forms. Collected on half million dollar claims.

Allied Billing Service: Biller/Collector 10/2001-01/2007 Experienced in performing payer, self pay collections, follow-up functions from charge entry of claim to final payments received from claim of physician office charges, DME and facility charges to include Medicare, Medicaid as well as HMO, PPO carrier billing, and 3rd party billing. Excellent working knowledge of insurance carrier billing regulations and requirements including claims submission, claims follow up, appeals process and focused review process, to include bad debt processing and collection agency referral, full understanding of state insurance laws and various appeals process including but not limited to insurance commission filing. Excellent understand of Payer EOB for review of payment and contractual adjustments. Knowledge of benefit requirements online claim editing, submission and reconciliation procedures. Education:

Peoria High School-High School Graduate

Glendale Community College-2004 Various Courses

Skills:

Medical Manager, SMS, Misys, Artiva, and various other custom computer systems Type 40+wpm. 10 key by touch, excel, word, bilingual.