Collection Specialist Medical Billing
Resume:
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
**********@*****.***
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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