GRACE RIVERA

adx0xb@r.postjobfree.com 347-***-**** East Stroudsburg, PA 18301

Summary

Detail-oriented Revenue Cycle Specialist with a systematic nature and good grasp of billing processes. Successful at resolving disputes and billing inquiries. Detail-oriented individual with 25 years of experience performing intricate billing procedures with undeniable level of detail. Familiar with private and commercial insurance carriers. Successful planner and problem-solver. Ready to apply 25 years' experience and take on a challenging role.

Skills

Impact Assessment

Debt Restructuring and Refinancing

Chart and Graph Preparation

Report Preparation and Presentation

Timing Optimization

Audit Procedures

Claims Processing

Medical Billing and Collections

Billing Dispute Resolution

Accounts Receivable Expertise

Invoicing Proficiency

Invoice Documentation Management

Charge Slips

Billing Data Verification

Account Posting

Financial and Economic Data

Customer Communication

Risk Assessment

Data Summaries

Business Analysis

Database Building

Experience

Caduceus Inc Jersey City, NJ

Revenue Cycle Specialist/Helpdesk Support

10/2009 - 06/2023

Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.

Answered customer invoice questions and resolved issues discovered during invoicing and collection process.

Investigated and resolved issues to maintain billing accuracy.

Contacted insurance providers to verify insurance information and obtain billing authorization.

Worked with team members and leadership to identify and develop process improvements.

Researched and resolved billing inconsistencies and errors through individual and collaborative analysis.

Completed billing audits in identified timeframes to report and investigate findings.

Performed data import, scanning or manual keying processes to verify invoice accuracy.

Reviewed vendor documentation to comply with payment guidelines.

Assessed billing statements for correct diagnostic codes and identified problems with coding.

Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.

Presented regular status updates and workflow recommendations to senior management.

Participated in revenue cycle processes, working to maximize profitability and increase revenue.

Increased overall efficiency of standard practices through design and development of improved forms and expedited procedures.

Monitored revenue status and created detailed reports for senior management.

Detailed key revenue cycle information into thorough presentations to deliver to executives and management team.

Managed billing and collection processes as part of 12-member team.

Identified and corrected payment problems involving patients or third-party payers.

Developed financial analysis reports and presentations by applying acquired financial principles.

Supported customers having data connectivity issues, assisting with troubleshooting steps and rebooting of hardware.

Troubleshot daily IT desktop client issues, supporting multiple departments and various offices.

Assisted customers by troubleshooting and resolving technical problems.

Created new accounts, reset passwords and configured access to servers and file management software for users.

Managed user profiles, security access and shared file structures.

Trained new employees on support processes, procedures and knowledge base.

Reviewed support cases for technical and troubleshooting accuracy and identified needed process improvements.

Developed and maintained positive customer relationships resulting in increased account services and expansion.

Delivered on-site technical support following software implementation and worked with managers to suggest product upgrades and changes.

Supported customers with online billing, access and account issues.

Montifiore Medical Center The Bronx, NY

Revenue Cycle Analyst

01/2000 - 10/2009

Applied HIPAA privacy and security regulations while handling patient information.

Communicated with insurance representatives to complete claims processing or resolve problem claims.

Completed and submitted appeals for denied claims.

Submitted appeals using provider portals and phone communication.

Coordinated communications between patients, billing personnel and insurance carriers.

Reviewed account information to confirm patient and insurance information is accurate and complete.

Input details into accounts and tracked payments.

Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.

Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.

Leveraged EMR software to post payments received for medical services.

Maintained billing software by updating rate change, cash spreadsheets and current collection reports.

Scheduled appointments for patients via phone and in person.

Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.

Organized charts, documents and supplies to maintain team productivity.

Developed curriculum and learning materials to increase comprehension.

Developed, deployed and maintained robust training programs accomplishing department and facility goals.

Demonstrated knowledge of varied learning modalities.

Utilized knowledge of industry best practices to improve upon existing training methods.

Implemented employee training programs to improve performance and productivity.

Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.

Demonstrated leadership by making improvements to work processes and helping to train others.

Education and Training

St Helena Business High School The Bronx, NY

High School Diploma

06/1988

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