Medical Billing Customer Service

TAMMY GUTIERREZ

602-***-**** • ***********@*******.***

Medical Billing Coordinator

Customer Service • Strategic Planning • Office Coordination

Seasoned and efficient medical billing coordinator with demonstrated expertise in customer service, office coordination, billing and collections, and process improvement. Possess CPT and ICD-10 physician coding experience with leadership and teaching skills. Familiar with medical and coding terminology and have excellent analytical and detail-oriented organizational skills. Possess strong commitment to team environment and efficiently work under pressure and within appropriate time allotments. Apply advanced critical thinking skills in a working environment where multi-task skills are essential. Effective communicator, skilled at connecting with diverse individuals.

Core Competencies:

Customer Service Strategic Planning Claim Adjudication Account Management Billing Management

Claim Management Process Improvement Partnership Development Project Management Patient Collections

Coding Technical Skills Medical & Coding Terminology Effective Communication Auditing Conflict Resolution

Organizational Effectiveness Resource Management Reimbursements Insurance Verification Office Administration

Professional Experience

ADDISON GROUP/TERROS HEALTH ASSIGNMENT June 2022 – Sept. 2022

Benefits Specialist

Seasoned Veteran of benefit programs and working with people that have different Mental abilities. More than 15 years of experience in fast-paced Environment. Excellent Computer and Interviewing skills. Track record of achieving exceptional results in helping people with mental illnesses get the services needed and give their families the Peace of Mind needed.

Interview benefits recipients at specified intervals to certify their eligibility for continuing benefits.

Interpret and explain information such as eligibility requirements, application details, payment methods, and applicants' legal rights.

Interview and investigate applicants for public assistance to gather information pertinent to their applications.

Keep records of assigned cases, and prepare required reports.

MOUNTAINPARK HEALTHCENTER, Phoenix AZ May 2020 – May 2021

Referral Coordinator

Accepts referral requests from providers. Confirms all necessary documents and information is provided to process the request. Confirms demographics including correct insurance information in EMR and updated as necessary. Evaluates the urgency of referrals and prior-authorizations and processes accordingly. Adheres to referral and prior-authorization SLAs. Communicates status to patients and informs them of any delays. Relays status to appropriate provider, support staff, and member of management.

• Promptly resolves service issues and complaints and defers to management or clinical personnel when necessary.

• Commended for providing prompt and exceptional service to all customers.

UNITED SURGICAL PARTNERS INTERNATIONAL, Phoenix, AZ Jan. 2019 – April 2020

Medical Billing & Collections Coordinator

Processed charge and payment entries within electronic health record. Coordinated and clarified with providers on incomplete information for proper account/ claim adjudication. Corrected, completed, and processed claims for all payer codes. Analyzed and interpreted claims and ensured they were accurately sent to insurance companies. Followed-up with Medicare, Medicaid, Medicaid Managed Care, and commercial insurance companies on unpaid insurance accounts identified through aging reports. Processed appeals online or via paper submission. Assisted in reconciling deposit and patient collections and billing audit-related information. Processed refund requests. Communicated with billing and credentialing coordinator to identify and resolve audit review issues. Processed billing calls and questions from patients and third-party carriers. Communicated daily with internal and external customers via phone calls and written communications. Identified trends and carrier issues relating to billing and reimbursements and reported findings. Attended provider meetings/workshops.

Handled late accounts effectively securing $15K in past-due accounts.

Gained a reputation for working well on a team, receiving “Team Player Award”.

Recognized for attention to detail, knowledge of medical terminology, great communication skills, strong moral character, independently driven, and focused.

Pursued and participated in education to remain current with changes in the Healthcare industry.

SOVEREIGN HEALTHCARE, Phoenix, AZ Feb. 2018 – Dec. 2019

Insurance Verification Specialist / Financial Counselor

Verified all patient eligibility, authorizations and benefits, claim information with insurance companies, and 3rd party payers prior to surgery. Determined patient’s responsibility, amounts to be billed, contractual discounts, and other applicable authorized discounts. Communicated information for preparation of the pre-admission process. Identified patient accounts accurately based on patient’s plan, PPO, HMO, and all managed care organizations. Contacted patients to obtain additional required information, documentation, and insurance card information. Informed patient of financial responsibility due at time of service, such as co-pay, deductible and coinsurance.

Orchestrated timely follow-ups with physician's offices to ensure clinical documentation request were initiated per insurance companies' protocols.

Prioritized all insurance verification and authorization within a timely manner by working directly on-line with various insurance companies.

Maintained insurance plan request database, ensuring data was entered accurately and in a timely manner.

REMX / MCKESSON SPECIALITY PHARMACY ASSIGNMENT, Phoenix, AZ Oct. 2017 – Jan. 2018

Reimbursement Coordinator

Provided product specific reimbursement support to patients, healthcare providers, patient advocates, and manufacturer representatives in a fast paced, high-volume contact center. Partnered with healthcare providers and patients to assist with appeal management for claim denials. Collaborated with physicians and payers to advocate for product specific coverage per payer specific committee protocol. Communicated product benefits efficiently and positively influenced payer policy. Interacted via telephone with commercial payers to conduct insurance verifications and benefit investigations. Worked daily with commercial payers to ensure appropriate coverage and reimbursement in a variety of therapeutic areas. Obtained payer specific prior authorization procedures and documentation requirements. Facilitated prior authorization process for patients and healthcare providers.

Effectively utilized internal resources to conduct external research and identify alternate funding sources.

Demonstrated working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan benefits, as well as an in-depth understanding of Medicare and Medicaid programs.

UNITED HEALTHCARE MILITARY & VETERANS, Phoenix, AZ Feb. 2013 – Oct. 2017

Senior Subject Matter Expert – Authorization & Referral Management Operations (2014 – 2017)

Maintained ongoing communications with Military Treatment Facility (MTF) Referral Management Center and MTF TRICARE Operations staff to resolve identified referral and authorization issues. Assisted staff with inquiries, correspondence, claims issues, and urgent referrals. Forecasted and monitored inventory levels based on inbound receipts. Assigned work based on business needs and work queue inventory. Collected, evaluated and analyzed efficiency reports, system access reports, and quality reports to provide improvement, accountability, and coaching measures. Supported medical management team on improvement in referral processing, utilization management, case management, and integrated behavioral health initiatives by identifying and tracking systemic issues and supporting implementation of resolution. Identified and reported potential risk management and quality of care issues. Assisted civilian providers with benefits, referrals, claims, ROFR process, command approvals, and eligibility. Performed daily team huddles regarding individual performance metrics to include efficiency, productivity, utilization, and quality.

Recipient of numerous “Bravo Awards” for demonstrating collaboration, performance, and relationships.

Provided input and ideas regarding process changes to assist with streamlining and workflow on a weekly basis.

Identified, addressed, and corrected process gaps within the work instructions between departments.

Conduct quality audits, identify coaching opportunities and schedule one-on-one training and coaching sessions with team members via Webex or side-by-side which improved quality from 82% to 97%.

Assisted with escalated issues from clinicians, upper management, RML’s and TRO, which include coordinating with other departments to determine an outcome and response.

Utilize Omega and TNOC to view, manage and improve staff performance and metrics to maintain a low percentage of lost time and steady increase of utilization and productivity.

Utilized NDB, CCM, WEBDOES and PIMS for daily provider and beneficiary inquiries.

Authorization & Referral Management Coordinator (2013 – 2014)

Accepted referrals and prior-authorization requests from providers. Confirmed all necessary documents and information was provided to process the request. Confirmed demographics including correct insurance information in EMR and updated as necessary. Evaluated the urgency of referrals and prior-authorizations and processed accordingly. Adhered to referral and prior-authorization SLAs. Communicated status to patients and informed them of any delays. Relayed status to appropriate provider, support staff, and member of management.

Promptly resolved service issues and complaints and deferred to management or clinical personnel when necessary.

Commended for providing prompt and exceptional service to all customers.

~ Additional experience as Orthopedic Technician & Patient Care Coordinator for Valley Orthopedics ~

Education

Government NAC Clearance Department of Defense (2013 to Current)

CPR Certified ~ Fingerprint Clearance Card

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