Shalbe Valero, CPC, CMR S

advvs9@r.postjobfree.com

SHALBE VALERO, CPC, CMRS

*** ********* ******. • Tiverton, Rhode Island 02878 401-***-****• advvs9@r.postjobfree.com

BILLING OFFICE MANAGER

MEDICAL BILLING / CODING SPECIALIST

Highly Skilled medical billing and accounts receivable with over 15 years of medical and business office billing experi- ence. Proven expertise working with patients to resolve Medicare / Medicaid denials and submitted appeals to correct the issue and collect the monies owed. I am skilled at medical coding, medical billing, processing medical claims, and performing insurance research as well as other business office manager duties. AP / AR • Medical Terminology • Collections • General Ledger • Office Administration • Medical Coding / Billing ICD 9 / ICD 10 •MACRA • HCPC • Anatomy / Physiology • Medicare / Medicaid • Employee Training • HIPPA Standards Customer Service • Insurance Policy Analysis • Communication • Phone Operations and Etiquette 5/2022-12/2022 Meeting Street - 1000 Eddy Street Providence, RI Reimbursement Specialist - Preform accounts receivable functions including billing third party payers, A/R tracking, payments processing, denial management and follow-up. Retains records necessary for third party reimbursement and compliance with accounting requirements and government regulations. Maintains accurate client billing database in the agency computer system (Welligent). Establishes and maintains excellent rapport with third party insurance contacts. Ensures timely billing of school districts for tuition and follow up on outstanding A/R 7/2020 - 5/23/2022 Linn Health & Rehabilitation - Aldersbridge Communities - 30 Alexander Ave East Providence, RI 02914

Billing Office Manager - Maintained daily accounting and updates for the residents accounts with the correct payer in- formation. Upload insurance claims into EPremis for submission to insurance companies. Verify patient eligibility for Skilled Nursing Facility care. Provide timely Medicaid billing for charges within residents eligibility dates. Ensure proper payment of Medicaid, Medicare and residents liability. Consolidate SNF billing and work with residents and family mem- bers to obtain financial resources, benefits, and necessary documents. Prepare facility invoices for residents accounts and prepare medical claims for insurance. Stay current with Medicare policies and procedures. Participate in work- groups and meetings as required. Report daily census. 10/2017 – 7/2020 (Facility Closed)

Episcopal Housing Foundation of RI DBA Hallworth House - 66 Benefit St Providence, RI 02904 Billing Office Manager - Maintained daily accounting and updates for the residents accounts with the correct payer in- formation. Upload insurance claims into EPremis for submission to insurance companies. Verify patient eligibility for Skilled Nursing Facility care. Provide timely Medicaid billing for charges within residents eligibility dates. Ensure proper payment of Medicaid, Medicare and residents liability. Consolidate SNF billing and work with residents and family mem- bers to obtain financial resources, benefits, and necessary documents. Prepare facility invoices for residents accounts and prepare medical claims for insurance. Stay current with Medicare policies and procedures. Help with accounts payable and admissions. Prepare month end financial reports. Keep accurate residents personal needs account as re- quired by Medicaid. Handle the Facility banking accounts with reference to check recording, cash disbursement journal entries and prints of checks.

Shalbe Valero, CPC, CMR S

advvs9@r.postjobfree.com

Achievements:

• Brought in uncollected revenue with in three months

• Set up access to Medicare Fiscal Intermediary Standard System

• Corrected Matrix and EPremis because it was incorrectly set up

• Set up electronic payments for multiple insurances

• Set up Rep Payee account for Medicaid resident

1/2015 – 10/2017 JUGAN RESIDENCE OF THE LITTLE SISTERS OF THE POOR INC. - PAWTUCKET, RI 02860 Business Office Manager - Maintained daily accounting and updates for the residents accounts with the correct payer information. Prepare end of month finical reports and review monthly finical budget. Enter claims directly into the Medicare Fiscal Intermediary Standard System and verify patient eligibility for Skilled Nursing Facility care. Provide time- ly Medicaid billing for charges within residents eligibility dates. Ensure proper payment of Medicaid, Medicare and resi- dents liability. Consolidate SNF billing and work with residents and family members to obtain financial resources, bene- fits, and necessary documents. Prepare facility invoices for residents accounts and prepare medical claims for insur- ances. Keep accurate residents trust accounts and financial records to comply with State regulations. Handle the Facility banking accounts with reference to check recording, cash disbursement journal entries and prints of checks. Stay cur- rent with Medicare policies and procedures

Achievements:

• Decreased Medicare accounts receivables, denials and outstanding vendor balances.

• Set up access to Ability for Medicare billing.

• Recently received approval for the BC/BS contract without JACO

• Completed working with Social Security on Rep Payee Applications for the NF residents OPTUM 360 • Providence, Rhode Island • 4/2009 – 12/2014 Proven revenue cycle operations expertise with market-leading technology. Accounts Receivable Associate / Senior Billing Representative Handle A/R issues including resolving payment denials, submitting appeals, entering data, processing medical claims, researching insurance policies, and correcting patient billing and claims information. Review and update patient state- ments and claims status on insurance websites. Maintain A/R under 90 days and ensure of follow up of outstanding ap- peals.

Achievements:

• Promoted to Senior Billing Representative for reducing aged claims. Worked five assignments with no timely filling denials.

Shalbe Valero, CPC, CMR S

advvs9@r.postjobfree.com

JOHN CLARKE RETIREMENT CENTER • Middletown, Rhode Island • 3/2005 – 2/2009 Retirement and Nursing Center offering home and neighborhood style amenities and healthcare. Bookkeeper/Administration

Maintained daily accounting and update residents payment accounts with correct payer information. Performed data en- try and records archiving. Entered claims directly into the Medicare Fiscal Intermediary Standard System and verified residents eligibility for Skilled Nursing Facility care. Provided timely Medicaid billing for charges within residents eligibili- ty dates. Ensured proper payment of Medicaid and Medicare and residents liability receivables. Consolidated SNF billing and worked with residents and family members to obtain financial resources, benefits, and necessary documents. Pre- pared facility invoices and outstanding residents accounts and insurance balances. Handled facility accounts including recording cash disbursement with journal entries. Stayed current with Medicare policies and procedures. Achievements:

• Increased Medicare accounts receivable and decreased denials and outstanding vendor balances. Implemented access to FISS program for Medicare Billing by bringing billing in-house.

• Received Employee of the Month recognition.

INTERNAL MEDICINE AND CARDIOLOGY ASSOCIATION OF SOUTHEAST NEW ENGLAND Fall River, Massachusetts • 3/2002 – 10/2004

Medical Doctor's Office providing cardiologist and cardio-vascular specialist services. Billing Coordinator

Performed patient medical coding and data entry. Prepared medical statements for mailing and checked forms for er- rors. Collected outstanding balances and provided patients and families HIPPA compliant billing and insurance informa- tion. Updated patient payments and credits, verified insurance eligibility, prepared daily bank deposits, and handled pa- tient insurance questions. Utilized Sense software program to run A/R reports and work claims over 30 days. Provided follow-up for denied claims, claims status, and prepared appeal letters. Researched and reviewed medical charts for diagnosis and procedure codes, and worked with physicians and nurses for questions on patient treatment. Helped train new staff and assisted with office administration. Career Note: Prior positions include Office/Dispatch Supervisor with Thrifty Oil Accounts Receivable / Billing with Van- guard Home Medical Equipment, Clinical Representative / Secretary with Medical Billing Service and Office As- sistant with Newport Nutrition. Details available on request. Shalbe Valero, CPC, CMR S

advvs9@r.postjobfree.com

EDUCATION

Accounting Fundamentals Certificate

Bristol Community College, Fall River, Massachusetts Medical Secretary Diploma

Kinyon-Campbell Business School, New Bedford, Massachusetts Medical Coding Program Certificate of Completion

Medical Terminology, Anatomy & Physiology, Medical Coding Allied Business School, Laguna Hills, California

PROFESSIONAL TRAINING

AAPC Certified Coder

CPC/ Coding Certification ID# 01176307

ICD-10-CM Proficient

MACRA Proficient

American Medical Billing Associate Certification

Certified Medical Reimbursement Specialist ID#6798810 Medicare Webinars

Lilly Parker Webinars

COMPUTER SKILLS

Microsoft Office Suite,

CareTracker

IDX

Point Click Care

Ability

Medicare Fiscal Intermediary Standard System

Matrix

EPremis

Welligent

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