Customer Service Patient Services
Resume:
DARLENE SOTO
South El Monte, CA 91733
*********@*****.***
Objective: Highly organized and effective patient services representative with strong history of medical office operations and fulfillment of role responsibilities. Skilled at providing patient outreach and communications with ability to diffuse complaints and calm any concerns. Seeking a position to utilize and enhance knowledge, experience, and education in a growth-oriented company. Solid work history showing a track record of efficiency and accuracy. Proven ability to meet deadlines in high environments with keen attention to detail. Passionate about overseeing tasks from start to finish.
EXPERIENCE
03/2019 – PRESENT
SURGICAL BILLER, Freedom Vision Surgery Center
Gather and verify personal patient information.
Code diagnosis, surgical procedures, and billable implants/ hardware
Demonstrate knowledge and remain current regarding ICD’s current version, CPT codes, modifiers, CCI-edits.
Post received payment and verifying claims are paid per each contract rate.
Appeal any underpaid or denied claim when needed.
Responsible for analyzing monthly Accounts Receivable reports
Provide clarity and resolutions to Patient and Insurance companies questions or concerns.
05/2007 – 03/2019
BILLING CODING SPECIALIST, EYESHETICA
Professional billing and coding for a group for a group of six surgeons specializing in Oculoplastic and Reconstructive surgery.
Maintain confidentiality of hospital and individual patient information.
Review op reports for coding, scrub claims to ensure proper cross coding of CPT and ICD10 codes.
Prepare and submit clean primary and secondary claims to various insurance companies either electronically or paper.
Audits daily reports to ensure that all patients appointments are billed and / or reconciled.
Works closely with A/R team with tasks, and appeals, and reopening.
Extensive knowledge HMO, PPO, Medicare, and Medi-Cal plans.
Aging reports, Appeals, daily deposits, correction of clearinghouse uploads and downloads of EFT payments, statements, and collections.
09/2005 -05 /2007
FINANCIAL COUNSELOR, CHILDRENS HOSPITAL
Insurance verification, authorization, pre-certification for MRI/CT scans, new patient registration.
Checking in/outpatients, surgery scheduling, resolved patients billing issues, billed with contact lens orders.
Traveled from main office to satellite office transportation charts/deposits and office supplies as needed.
Copying, faxing answer and screen a high volume of calls daily, and outstanding customer service to patients.
11/1995- 09/2005
LEAD SCHEUDLING SECRTUARY, DOHENY EYE MEDICAL
Patient Scheduling, patient registration, insurance verification, responsible for physician schedules and creating statistics reports for main physician. Took minutes for monthly Operations meeting.
In charge of call triage, answering high volume of calls daily, outstanding customers service.
Maintenance of physician scheduling templates.
Message taking for physicians and back-office technicians.
Effective written and verbal communication skills.
EDUCATION
Precision Medial Services LLC; Hacienda Heights, CA
Professional Coding, 2009 (CPC) # 01128911
American Association of Professional Coders; AAPC
SKILLS
Microsoft Word, Excel, Outlook. Use of Encoder Pro, IDX, NextGen, Oracle, Advantx, SIS Complete, Waystar, Navicure. CPT Coding, Billing, Claim Submission, Claim Follow Up, Insurance Verification, Statements, Patient Billing, ABN Forms, NCCI Edits, Insurance Appeals, Payment Posting, Charge Posting, Faxing, Filing, Copying, and Outstanding Customer Service.
Languages: Bilingual English/Spanish
Typing Speed: 35 wpm
*References Upon Request
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