ARLEEN QUINONEZ

**** **. ***** ******* *******, FL 32771 407-***-****

adx41p@r.postjobfree.com

SUMMARY: MORE THAN 15 YEARS OF BILLING AND COLLECTOR EXPERIENCE IN SPECIALTY PHARMACY, WORKERS COMP, AUTO COMP COMMERICAL, MEDICAID, MEDICARE, GOVERNMENT PLANS, AND PATIENT ASSISTANCE PLANS.

ANALYTICAL MANAGES REPORTING LEADERSHIP NEGOTIATIOR

REALTIONSHIP BUILDING

EXPERIENCE

August 2021 – Current

Billing Coordinator, Truehealth

● Work insurance AR and denials

● Key claims into Medicaid portal

● Answer patient calls about bills

● Assist in creating claims

● Training with new hires

November 2019- August 2021

Appeal Coordinator, Bioplus

● Maintained a relationship with MDO and patient to assist in retrieving documents that were needed to submit with the Appeal.

● Follow up on appeals that were submitted to the insurance plans.

● If the appeal was not received, then I would fax and or mail it out to the plan.

● Escalated issues when turnaround times may be missed.

● Assisted in obtaining PA Authorization denial letters. OCTOBER 2014 – November 2019

RCM SPECIALIST, OPTUM UNITEDHEALTHCARE

Developed billing and collecting methods to constantly lead to reaching or above company A/R financial goals.

Analyzed medical and pharmacy claims greater than 45 days where has been denied, partially paid, or taken back to correct on HFCA or UCF form and submit to plan for full contracted payments.

Constantly decreasing company Accounts Receivable by 35% quarterly by steadily following up on claims for payments.

Ensure proper coding ICD-9, ICD10, HCPCS, CPT on HFCA or UCF forms. Review Explanation of Benefits to determine if appeals, refunds or write offs is a necessary plan of action to resolve the claim in a non-paid status.

Steadily kept the Daily Sales Outstanding (DSO) under 30 days SEPTEMBER 2009 – OCTOBER 2014

RCM BILLING COLLECTIONS ANALYST, AXIUM

PHARMACY/KROGER SPECIALTY PHARMACY

Analyze claims greater than 90 days to identify the denial reasons to correct the initial mistakes and re submit for possible full payments from plans.

Collected documents from providers to submit an appeal to plans to overturn original denial decision.

Managed initial billing claims on HFCA forms within 24 hours to ensure first time submission is successful electronically.

Make outbound calls and take inbound calls from insurers, patients, providers to get claims resolved.

Constantly followed up with payers for claim status and payment status via phone or portals.

Collect inbound patient calls to set up for payment arrangements as well as take full payments over the phone.

Verified patient’s benefits and loaded all information into system for accuracy billing.

Steadily kept the Daily Sales Outstanding (DSO) under 25 days JUNE 2007 – APRIL 2009

RCM BILLING COLLECTIONS ANALYST, PMSI

Primary Point of contact for Workman’s Comp, Auto Comp and Big group insurances. Pulled A/R reports daily to identify errors to correct and re submit to plan for full payment per contracted payment.

Constant daily communication with external clients such as insurance company adjusters, doctors, and physical therapy clinics for updated IME reports,

prescriptions, referrals medical record authorizations and retro authorizations to keep on file.

SEPTEMBER 2005-JUNE 2007

SENIOR BILLING AND COLLECTION SPECIALIST, Electrostim Medical Services

Primary Contact with Worker’s Comp, Auto Comp, and other insurances claims. Specialized prior authorization and retro authorization to keep patient case active and paid appropriately.

Billed initial and corrected claims using CMS-1500 and DWC-10 forms.

Appeal denied claims using workers comp, auto comp appeal procedures. Pulled daily A/R over 60 days to collect on the past due revenue.

Managed to keep the claims under 90 days past due EDUCATION

JANUARY 2005

MEDICAL BILLING AND CODING, EDUTECH

Graduated with honors in ICD-9 coding, CPT coding and HPCS codes and medical terminology

SKILLS

Microsoft Word, Excel, PowerPoint, and Access Programs

ICD 10 coding

Type 50 WPM

10 Key Skills 2

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