JUAN SOTO

*** *. ****** ******

Allentown, P.A. *8102

551-***-****

adyrso@r.postjobfree.com

CAREER OBJECTIVE

Seeking a challenging position where I can utilize my extensive experience within the clerical/admin arena along with my certification as a Medical Billing and Coding Specialist

SUMMARY OF EXPERIENCE

•Screened patients on a daily basis for Medicaid and Charity Care; refer patients to their local county offices to complete the application qualification process.

•Audit all Medicaid vouchers received and submit with proper documentation to UNYSIS for claim processing.

•Handle A/R claims and act as a liaison with commercial insurance companies for proper claims processing.

•Prepares special projects for senior management and director and report all errors on documentation listings.

•Trains staff on all policies and procedures and hold monthly staff meetings with updates and goals needed to meet our quota.

•Recruited for diverse roles and functions within multiple business departments and their affiliates.

•Electronically batched and submitted Medicaid claims and review vouchers for denials and error codes and resubmit batches for proper approval of all claims.

•Follow up on claims denied by commercial insurance companies and resubmit for processing.

•Answer patient inquiries and help resolve issues pertaining to over charged accounts and or collect copays over the phone.

•Modified and revised employee handbook as well as company policies and procedures, job descriptions..

•Assisted in recruitment of potential employees and current employees wishing to advance within the /company.

•Consistently pursues customer satisfaction and immediately address any potential client concerns as priority

WORK EXPERIENCE

Medical Billing Technician

01/2022- Present

Matheny Project- Remote

Work Medicare claims from billing through payment, including any rejections and/or billing errors that are returned

Navigate the DDE and resolve Medicare accounts through editing, suspense, and RTP status

Reconcile RTP and corrects errors/rejections

Draft appeals to ensure timely resolution and payment of claims, as well as argue verbally over the phone where warranted to get denials overturned and paid

Perform contractual analysis on paid claims to ensure that our client hospitals are reimbursed accurately and according to contract, and to ensure payment integrity

Develops external relationships with third party agencies that can assist in the billing

process if needed

Involve key players in an account and effectively use internal employer resources to provide the best client solution.

Report any reimbursement trends/delays to the supervisor

Effectively utilize various means for collections, including but not limited to phone, fax, mail, and online methods including but not limited to the DDE

Attend meetings and complete post-meeting reports and summaries

Establish regular communication with the client regarding outstanding issues and program performance

Assists with audits and related documentation requests

Develops and fosters a collaborative working relationship with other departments and

team members throughout the organization

Participates in Finance department staff meetings and professional growth training

opportunities

Medical Billing Specialist A/R 07/2018-11/2021

Office Practicum, Remote

•Review unpaid claims and research reasons for delay

•Develop and maintain positive working relationships with team members

•Review outstanding accounts and aging report

•Initiate collection follow up of unpaid or denied claims with the appropriate payer

•Research appeal and resolve claim rejections, underpayments and denials with payers

•Process appeals by gathering information and resubmitting claims

•Communicate payment or denial trending that impact revenue to leadership

•Contact insurance companies to work out any discrepancies and get the claims paid

•Strong computer skills with high attention to detail is a must

•Comprehensive understanding of accounts receivable management in a healthcare setting

•Run Day sheets

•Promptly repair and/or resubmit any claim batches that are not acknowledged within 24 hours or initial submission

•Convert superbills that are ready to be billed to claims and apply proper modifiers if not blocked and substituted

•Check previous days to see if older superbills have become ready to be billed

•Bill carriers by inputting billing information into Office Practicum and initiating electronic transmissions

•Submit insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 forms

•Log into Clearinghouses and check previous days’ claims that were submitted, if any rejections, fix immediately (if fixed in clearinghouse, also fix claim in OP)

•Provide client feedback on any coding errors or omissions

•Resolve discrepancies by consulting with physicians to examine and evaluate data, selecting corrective steps

Medical Billing/Coding 06/17-01/2018

Empire Specialty Pharmacy, West New York, New Jersey

•Established guidelines for proper coding/billing for providers.

•Worked hand in hand with front office staff to ensure that the proper information was received for claims processing.

•Oversaw and ran necessary reports to ensure that all statuses were worked in a timely manner and helped in any capacity necessary.

•Maintained and updated all files including insurance companies, diagnosis, procedure, fees/profiles.

•Worked collections which included mailing of correspondence, working with patients to establish promissory notes for payment and if necessary forwarded accounts to collection agency.

•Resolved billing issues identified by insurance carriers and patients.

•Reviewed claim denials and payer requirements for corrective action and prevention in the future.

•Researched and replied in a timely manner to insurance, patient, and internal customer inquiries.

•Kept accurate records of all activity and conversations for each fil

•Submitted electronic claims thru clearing house such as Zirmed and Navinet.

•Maintained the highest levels of accuracy and patient confidentiality

•Quickly identified and resolved medical billing, coding and insurance discrepancies

•Reviewed patient bills for accuracy and completeness, and obtained any missing information

•Followed the guidelines and be in compliance with local, state or federal laws and regulations

Reviewed accounts for possible assignment and made recommendations to the Billing Supervisor, also reviewed EOB’s for accurate payment and denials.

Intake/Authorization Coordinator II 07/15- 05/2017

Bioscrip/Infusioncare West Chester, P.A.

•Evaluates referrals against branch service model parameters.

•Complies with reimbursement for products and services in compliance with Company policy and goals, to include drug, supply, and equipment selection and utilization, and participates in the submission of clean claims through compliance to proper pharmacy billing procedures

•Communicates with various payors, referral sources, patients and sales representatives.

•Verify eligibility and benefits accurately and in a timely manner in accordance with Company policies.

•Obtain initial authorizations following and maintain authorizations extension for all patients as appropriate.

•Processes all required paperwork according to established procedures. Ensure all documentation needed for billing is collected prior to or soon after accepting the referral.

•Answers telephone calls and emails in a professional and timely manner.

•Attend all required in services throughout the year.

•Adhere to performance programs, policies, procedures, guidelines and internal control standards established to guide the operation of the Company. Understand proper internal control procedures associated with their specific job function as communicated by my manager.

•Responsible for reporting concerns that I may have with respect to deficiencies in internal control.

•Performs other duties as assign

•Knowledgeable of HCPC Codes and ICD-9 Codes and maintains up to date professional knowledge of Medicare, Medicaid and the insurance industry requirements for qualifying services.

•Strong interpersonal and communication skills and the ability to work effectively with departments.

•Knowledge of computerized information systems, including financial applications.

•Knowledge of infusion pharmacy durable medical and respiratory equipment reimbursement for state, federal and commercial payors.

•Ability to develop and maintain recordkeeping systems and procedures.

•Knowledge of the computer and its capabilities.

•Working knowledge of medical terminology.

•Ability to perform work in an organized fashion with focus on complete information and time related deadlines.

•Ability to complete multiple projects with time sensitive deadlines.

•Ability to manage more than one priority project at a time.

•Ability to work as part of a team to complete assigned tasks.

•Ability to exercise independent judgment and at times work independently.

•Ability to accept direction and complete work according to instruction.

•Ability to enlist cooperation of other people and department in completing assigned work and projects.

•Ability to work under high levels of stress.

•Ability to prioritize and handle multiple tasks and projects concurrently..

•Excellent verbal and written communication skills.

•Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office.

•Ability to work with confidential material and maintain confidentiality along with sensitivity to employee’s needs and data.

•Strong attention to detail.

COLLECTIONS AND INTAKE COORDINATOR 6/13 – 12/14

BioDynamic Technologies, East Rutherford, New Jersey

• Reviewing aging reports for bad debt collection from insurance companies

• Calling insurance companies for claim follow-ups and reprocessing claims for submission

• Submit medical claims electronically (EMC) and verifying claims received by Insurance companies

• Post payments to patient’s accounts and adjusting payments and refunding patients if refund is due

• Answer calls pertaining to patient bills, receiving faxes for new DME orders and confirming orders

• Obtaining Authorizations, Precertification’s Extensions for DME items requiring over $500

• Checking Medical Insurance Benefits and Eligibility for DME items

ASSISTANT MANAGER 03/02 - 09/12

ARMDS Clifton, New Jersey

• Served as the primary interface on day-to-day issues for one major or multiple clients and/or multiple service lines

• Participated in the activities of new client start-up and provides staffing support and training as directed

• Initiated and participates in client and JOC meetings and follows up on action items

• Ensured customer satisfaction and reports possible

• Assisted in completing, delivering and presenting monthly client reports and addresses client feedback to Director or

Associate Director

LANGUAGES

Fluent in English and Spanish

EDUCATION

EASTWICK COLLEGE, Nutley, New Jersey 9/13 – 9/14

Medical Billing & Coding Specialist Certification

MONTCLAIR STATE UNIVERSITY, Montclair, New Jersey

Medical Billing and Coding Certificate 1999

NEW HORIZONS- Bethlehem, Pennsylvania 01/2021- Present

Network+ /Support, Network Security, IT Service Management

CERTIFICATIONS

• Medicare A & B • NCCT • HIPPA • OSHA

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