Billing Specialist &Medical Assistant

BLANCA SUAREZ

**** ******** ** ******, ** ***** 219-***-****

(Email) *****************@*****.***

SUMMARY: Years of Management Experience/ Medical Assistant and Billing Specialist with exceptional people skills. Desiring a challenging role SKILLS: Remote billing, invoicing and billing specialist, scheduling management, interpersonal communication, contract negotiation, training and development EXPERIENCE:

CONIFER Remote work

Denial Specialist 4/2022 to 4/2023

• Responsible for validating dispute reasons following Explanation of Benefits review, escalating payment variance trends of issues to NIC management, and generating appeals for denied or underpaid claims. Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center

(CRC) for clinical consultations or account referrals, when necessary.

• Generate the appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. Follow specific payer guidelines for appeals submission. Escalate exhausted appeal efforts for resolution. Research contract terms/interpretation and compile necessary supporting documentation for appeals. Terms and Conditions for Internet enabled Managed Care System adjudication issues, and referral to refund unit on overpayments. Perform research and makes determination of corrective actions and takes appropriate steps to code the DCM system and route account appropriately.

FRANCISCAN ALLIANCE Munster, IN

Ambulatory Work Queue Specialist 10/2018 to 4/2022

• Responsible for carefully reviewing and inputting a variety of data that includes but not limited to patient demographics, patient insurance information, CPT/HCPC’s codes, ICD-10 codes, and provider information.

• Manages specific work queue related to ambulatory revenue cycle. Responsible for improving Ambulatory Revenue cycle workflow by correcting errors and evaluating educational needs in departments per analyzed work queue trends.

• Reduces and eliminates by correct use of modifiers, mapping and linking codes with services.

MOBGYN/FPN-OBGYN Munster, IN

Office Manager, and Medical Assistant 04/2013 to 04/2018

• Daily review of denials and payment reviewed all denied claims and validation of action needed for reconsideration. Resubmit all claims denied and follow up on all claims denied. Ensure denials are addressed in a timely manner and appropriate follow-up action is taken as defined by the respective policy. Provide documentation and data when needed.

• Contact patients for additional information needed to get claim paid. Document activity in an accurate and timely manner on patient’s account. Kept abreast of physician’s licenses and expiration dates, renewed contracts and handled all aspects of credentialing for seven providers. Reviewed and approved timecards for processing by payroll department.

• Interviewed, on boarding, developed and oversaw daily office activities. Monitored and controlled office inventory to ensure adequate supply level, timely product ordering and efficient management of company resources. Evaluated and identified ineffective workflow processes to device and implement solutions which achieved greater productivity and personal performance.

• Evaluated performance of office staff to monitor progress and productivity and recommended promotions, as well as corrective or disciplinary actions. Implementing rules and regulations that were required and expected of all Franciscan employees. Reviewed all Mandatory management reports.

• Attended all required Practice Manager meetings. Work the A/R for insurance companies and patients. Gather and record patient history, surgical history, family history and vitals. Record all data gathered electronically. Schedule patient appointments and assist providers with exams and procedures.

• Injections and specimen collection and lab requisition forms completed

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