Posted all accounts receivables

Responsible for A/R management

Monitored and resubmitted unpaid claims

Researched and resolved discrepancies on denied EOB/EOR Responsible for all contract reviews with insurance companies, and made recommendations Responsible for collecting and follow up on Workers' Compensation, BCBS, Commercial, HMO, Medicare, and Medicaid accounts

Handled all worker’s compensation negotiations

Filed liens for litigation cases

M O N I C A C O R O N A D O

BUSINESS ANALYST REIMBURSEMENT

A highly motivated, hard-working, and well-spoken bi-lingual medical billing professional with over 20 years of experience. Proven project management capabilities with great time management skills. Proficient in adjudicating claims for all types of insurance with strong analytic skills to review claim rules and workflows. Ability to multi-task, self-driven, organized, and detail-oriented.

A B O U T M E

W O R K E X P E R I E N C E

Determine accurate payment criteria for clearing pending claims based on defined policy and procedure

Ability to understand logic of standard medical coding Identify claims with inaccurate data or claims that require review by appropriate team members

Multiple surgery claim review

Research and apply physician and hospital contract pricing Resolve claims that require adjustments

Consistently exceed production goals

Complete special projects

S K I L L S

Allscripts/Misys/Nextgen/Aldera

Software

Medical Coding

Subject Matter Expert: County Care

Claims Processing

Bilingual in English + Spanish

C O N T A C T

2712 Joe Adler Drive

Plainfield, IL 60586

adw0mf@r.postjobfree.com

773-***-****

Experience in claim adjudication platforms with an understanding of provider reimbursement methodology

Ability to understand the connection of a provider to a contract or fee schedule for reimbursement calculations

Reviewed medical agreements received from clients and created contracts—contracts were linked to multiple tickets to create for inventory needed for IQ testing Knowledge of heath insurance, HMO—managed care principles, including Medicaid and Medicare regulations

Ability to work independently and within a collaborative team environment with little guidance or supervision

Ability to successfully balance deadlines, projects, and day-to-day responsibilities Strong attention to detail and organization

Answered inquiries related to medical billing for 130 clinics via email and phone Identified and communicated payment trends to management, including payers, CPT codes, diagnosis codes and therapists

Followed up on outstanding account receivables, focused on maintaining aged receivables within 90 days DSO—included researching aged account reports, processing problematic EOBs and/or incoming mail and correspondence

Managed outstanding accounts receivables for assigned payers Resolved outstanding balances, resubmitted claims and provided necessary information to support prompt payment

Identified billing and coverage problems and communicated with clinic staff regarding billing requirements not being met

Processed claims for insurance carriers, including sending correct documentation and requesting missing information as needed

E D U C A T I O N

Wright Junior College

BUSINESS ANALYST, REIMBURSEMENT

2022-2023 EVOLENT HEALTH

CLAIMS ADJUDICATOR

2015-2022 EVOLENT HEALTH

COLLECTION SPECIALIST

2013-2015 ATHLETICO

BILLING SUPERVISOR

2001-2013 NORTHWESTERN NEUROSURGICAL ASSOCIATES

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