Data Entry Collections Specialist

Althea De Los Santos Garza

***** ********* **. *******, ** 77038 713-***-**** **********@*****.***

Objective

·To obtain a Team Lead position utilizing effective organizational and critical thinking skills. Excel as a team player and working with minimum supervision; for the continuing success of your organization.

Experience

COLLECTIONS SPECIALIST TYVAN BILLING JANUARY 2020 TO PRESENT

Research errors on claims and makes necessary corrections for clean claim production and submission.

Actively follow-up and collect on all electronic claims, including resolution of any billing errors, submit adjustment requests, posting inquiries, and coding inquires.

Utilize aging reports to follow up on unpaid claims aged over 30, 60, 90, 120, and 180 plus days.

Review accounts and generate appeal letters to insurance carriers when not in agreement with claim denial to ensure maximum entitled reimbursement. Specifically Out of Network and Low Allowable appeals for commercial and Medicare insurance carriers.

Review insurance EOBs and generate appeals or patient statements accordingly.

Resubmit insurance claims that have received no response or are not on file.

Resolve all customer requests, inquiries, concerns, in an expedient and respectful manner.

Identify trends on aging reports providing appropriate feedback to management..

Submit secondary claims upon processing by primary insurer for patients with coverage by more than one insurer.

Ensure maximization of collection dollars from insurance companies in accordance with the respective contracts.

Review and approve patient statements for charges not covered by insurance or patient responsibility.

Provide clear and concise documentation of every action taken on an account in the system collection notes.

Assist manager obtain missing EOBs and payment information.

Generate patient correspondence requesting patient involvement, insurance information, or other requested information.

Respond to payer’s requests for additional information or documentation.

INSURANCE ACCOUNT RESOLUTION SPECIALIST PFS GROUP FEBRUARY 2019 TO JANUARY 2020

Research accounts, refiling claims, and preparing necessary information for claim appeals.

Enter information necessary for insurance claims such as patient, insurance ID, authorization numbers, and provider information. Insure claim information is complete and accurate.

Make necessary arrangements for medical records requests or additional documentation requested internally or externally.

Tracking accounts status by monitoring and analyzing assigned unresolved third party accounts.

Initiate internal or external contact and negotiate appropriate account resolution on outstanding UB-04 or HCFA 1500 claims.

Receive and resolve inquires and correspondence from third parties and patients.

Research patient responsible portions, copays, deductibles, write-off amounts, for non-covered services.

Read and interpret insurance explanation of benefits, and gather necessary correspondence accordingly.

Prepare patient correspondence requesting patient involvement, insurance information, or other requested information.

Follow HIPAA privacy requirements for patient information. Maintain and protect confidential information.

BILLING AND COLLECTIONS SPECIALIST MICHAEL G. CASAGRANDE, MD FAMILY MEDICINE JULY 2017 TO JANUARY 2019

Verify patient demographics, insurance information, update new information.

Enter information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes, modifiers, procedure authorization numbers, and provider information. Insure claim information is complete and accurate.

Follow HIPAA privacy requirements for patient information. Maintain and protect confidential information.

Full cycle billing

Answer phone calls, schedule patient appointments, assist patients and pharmacy staff members with patient refill requests.

Prepare patient referrals, fax referrals to providers.

Prepare and submit insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form for office, skilled nursing, assisted and independent living facilities.

Prepare and submit secondary claims upon processing by primary insurer for patients with coverage by more than one insurer.

Respond to inquiries from insurance companies.

Perform follow up calls with insurance companies on rejected claims and unpaid insurance accounts identified through aging reports. Resolves issue and re-submits claims.

Prepare appeal letters to insurance carriers when not in agreement with claim denial to ensure maximum entitled reimbursement. Collect necessary information to accompany appeal.

Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30, 60, and 90 days.

Accurately post all insurance and patient payments by line item using Allscripts billing software.

Timely follow up on insurance claim denials, exceptions or exclusions

Reading and interpreting insurance explanation of benefits, and prepare correspondence accordingly.

Make necessary arrangements for medical records requests, completion of additional information requests as requested by insurance companies.

Resolve patient questions on patient responsible portions, copays, deductibles, write-off’s for services are not covered.

Generate patient statements for charges not covered by insurance or patient responsibility. Ensure statements are mailed on a monthly basis

Work with patients to establish payment plans for past due accounts in accordance with provider policies.

BILLING MANAGER HOUSTON HEAD & NECK SURGICAL APRIL 2017 TO JULY 2017

Verify patient demographics, insurance information, update new information.

Enter information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes, modifiers, procedure authorization numbers, and provider information. Insure claim information is complete and accurate.

Follow HIPAA privacy requirements for patient information. Maintain and protect confidential information.

Answer phone calls, schedule patient appointments, assist pharmacy staff members with patient refill requests.

Prepare and submit insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form.

Prepare and submit secondary claims upon processing by primary insurer for patients with coverage by more than one insurer.

Respond to inquiries from insurance companies, patients and providers.

Perform follow up calls with insurance companies on rejected claims and unpaid insurance accounts identified through aging reports. Resolves issue and re-submits claims.

Prepare appeal letters to insurance carriers when not in agreement with claim denial to ensure maximum entitled reimbursement. Collect necessary information to accompany appeal.

Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30, 60, and 90 days.

Accurately post all insurance payments by line item using eClinicalWorks billing software.

Timely follow up on insurance claim denials, exceptions or exclusions

Reading and interpreting insurance explanation of benefits.

Make necessary arrangements for medical records requests, completion of additional information requests as requested by insurance companies.

Schedule surgical procedures with surgery center, process surgery orders, lab orders, and insurance authorizations for surgery cases. Verify insurance, collect copays, co-insurance fees for surgical cases.

Resolve patient questions on patient responsible portions, copays, deductibles, write-off’s for services are not covered.

Generate patient statements for charges not covered by insurance. Insure statements are mailed on a regular basis.

Prepare end of day payment reports.

Work with patients to establish payment plans for past due accounts in accordance with provider policies.

Determine ICD 10 diagnosis and CPT treatment codes from online service or using traditional coding references.

Process physician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing.

Responsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources.

Perform primary source verification via various state and national sources.

Maintain individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standards.

Oversee, updates and maintain provider credential database including CAQH, PECOS, NPPES Registry, Sharepoint any other applicable regulatory agencies.

Respond timely to provider inquiries by letter, phone or internal communication.

Work closely and maintain relationships with provider relations with each payer, and communicate any challenges and/or concerns with physician.

BILLING AND CODING SPECIALIST ONE STEP DIAGNOSTIC JUNE 2015 TO APRIL 2017

Verified patient demographics, insurance information, reviewed physician’s notes and obtain necessary clarification where necessary.

Prepared appropriate claim documents.

Entered information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes, modifiers, procedure authorization numbers, and provider information. Insure claim information is complete and accurate.

Accurately posted insurance and patient payments using Medics Premier billing software.

Prepared and submitted secondary claims upon processing by primary insurer for patients with coverage with more than one insurer.

Perform follow up calls with insurance companies on rejected claims and unpaid insurance accounts identified through aging reports. Resolves issue and re-submits claims.

Prepare appeal letters to insurance carriers when not in agreement with claim denial to ensure maximum entitled reimbursement. Collect necessary information to accompany appeal.

Followed HIPAA privacy requirements for patient information. Maintained and protected confidential information.

Looked up ICD 10 diagnosis and CPT treatment codes from online service or using traditional coding references.

Coded records by following prescribed coding standards such as ICD-10 and CPT codes.

Answered telephones and transferred to appropriate staff members

Other duties as assigned by management

ADMINISTRATIVE ASSISTANT HARRY GEE & ASSOCIATES, PLLC JUNE 2014 TO JUNE 2015

Welcomed all incoming clients and guests to the firm and offered refreshments to guests.

Answered multi line phones, directed and returned phone calls accordingly.

Maintained office staff In/out board.

Managed head attorney daily appointment calendar and assisted other attorneys scheduling appointments.

Completed all requested tasks from head attorney as they related to client activities.

Processed PNC (Potential New Client) files and created files.

Facilitated event coordination, organized out of office appointments for head attorney: RSVP’d and confirmed events

Scheduled and updated calendar for lunch or dinner reservations for head attorney.

Organized travel arrangements for head attorney including but not limited to: booking flights, hotel and rental car reservations. Obtained boarding passes 24 hours prior to flight time.

Maintained supply of assignment sheets, inside cover sheets, client information sheets, NIV/IV classification, naturalization and document release forms.

Logged attorney case assignments in the client tracking database and Globe.

Updated client contact Information as needed in Globe, ImmForms, and in client files.

Created, organized and maintained head Attorneys organizational “Purple” folders.

Applied postage to outgoing mail (including Certified/Express Mail) and log charges in Globe.

Picked up and dropped off USPS Mail downstairs as needed.

Opened, sorted, date stamped mail and distributed accordingly.

Prepared delivery slips for FedEx shipments and couriers (Sterling Express) for any attorney and management and posted charges in Globe accordingly.

Processed credit card, check, and cash payments accordingly

Posted all copy and fax expenses in Globe.

Posted all courier and messenger (FedEx/Sterling) expenses in Globe.

Collected long distance phone logs and posted charges in Globe.

Provided backup assistance to file clerks as necessary, primarily for mail procedures.

Kept reception area neat throughout the day and watered plants as scheduled.

Other duties as assigned by management

POLICE RECORDS SPECIALIST MD ANDERSONCANCER CENTER MARCH 2011 TO MAY 2014

Prepared, proofed, and distributed daily institutional police activity reports, processed citations, records requests, received, and distributed subpoenas, and filing.

Prepared monthly UCR and UT System crime reports.

Prepared and maintained daily crime and fire logs.

Sorted, filed, updated, archived, and maintained electronic and paper records.

Maintained an accurate database of current and archived records.

Assisted with preparing, disseminating, and retrieved records of UTPD employees.

Answered telephones and transferred to appropriate staff members, scheduled meetings and prepared travel requests for training classes.

Opened, sorted and distributed incoming records correspondence, including faxes and email.

Prepared responses to correspondence containing routine inquiries.

Performed general clerical duties to include, data entry, copying, faxing, mailing and filing.

Filed and retrieved organizational documents, records, and reports.

Created and modified documents such as, reports, or memos using word processing, spreadsheet, database and/or other presentation software such as Microsoft Office.

Maintained Departmental library.

Supported staff in assigned project based work and other duties as assigned by Supervisor.

EDUCATION

09/2013

Houston Community College

Houston, TX

11/2019 Certified Revenue Cycle Specialist – Institutional

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