Rosemarie Martinez

adscuf@r.postjobfree.com

714-***-****

Experience

Account management Services

3rd party medical collections

In Home Care Provider

IHSH Orange County

Responsibilities

December 2010 to Present

●Cook

●Clean

● Personal hygiene

●Drive to doctor appointments

Patient Account Representative / Collector

Account Management Services

August 2006 to Present

Responsibilities

●Bill and follow up claims with patients and providers for maximum collection of reimbursement.

●Appeal underpayments, non-paid, denied, incorrectly processed claims for resolution of claims.

●Verify eligibility, benefits, provider services, patient and insurance payment responsibility.

●Handle accounts receivable for hospital Commercial, Managed Care, Workers Comp, and TPL claims.

●Follow up on X-Ray clinics, physicians, based claims, as well as skip tracing for hospital unresolved claims.

●Translate for Spanish speaking patients who inquire and request their claims be resolved and handled.

●Resolve collection of their healthcare account balances, refunds, credit balances, Making payment arrangements.

●Research, review and respond to contracts, correspondence, denials and pending requests for reprocessing.

Rev Care –

Patient account representative

2002 to 2005

Responsibilities

●Collect Self/Private Pay Accounts for Saint Johns, Saint Francis, Saint Mary's and CHW hospitals.

●Followed up on self-pay and private pay negotiations, co-pay and deductible collections.

●Sent out statements to patients and if needed resolve claim issues with the payers for additional review.

●Explained plan benefits, verification, claims resolution and claim payment negotiations with patients.

●Sent to Philippines to train over 15 collectors for healthcare accounting and skip tracing techniques.

Patient Account Representative

Law Office of Banda

June 2004 to December 2004

Responsibilities

●Collected judgments for the law offices for credit cards

●Assist with collections and follow up of collecting and negotiating with credit card debt

●Explain credit card processing, billing and troubleshoot any transaction errors.

My Skills

●Knowledgeable of HMO, PPO, POS, Medicare Medi-Cal, Commercial, Managed Care.

●Medical terminology, data entry, type 45 wpm, billing, collections, EOB review, appeals.

●Contracts, Matrix, High Dollar, Stop loss, Fee Schedule, State/Federal laws, HPPA guidelines.

●ICD-9, CPT, HCPCS, REV, DX codes, UB-92, HCFA/CMS 1500 forms.

●AS400, Predictive Dialer, Cubs System, Collect one/ Lines.

●MS Word, Excel, Outlook Express, Internet Explorer Savvy.

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