Accounts Receivable Medical Assistant
Resume:
ALMA RESURA
ACCONUTING & BILLING SPECIALIST
PROFESSIONAL SUMMARY
Proficient Medical Collector/Biller with a proven track record in outpatient Ambulatory Surgery Center (ASC) environments. Possesses exceptional multitasking capabilities and showcases a collaborative disposition as a valuable team contributor. Known for maintaining a positive attitude and demonstrating strong teamwork attributes.
EXPERIENCE
Claim Analyst
Cross America Financial (CAF)
June 2021– March 2023
Managed daily attention to unpaid claims, ensuring claims were entered and submitted within 48 hours of receipt.
Worked on accounts from assigned areas to maximize reimbursement.
Conducted systematic, consistent, and timely follow-up on accounts.
Took appropriate actions to process accounts to resolution.
Worked on payer correspondence, edits, and aged accounts receivable to identify and correct billing errors.
Resolved unpaid/under-paid claims and handled collections on behalf of clients.
Obtained claim status through various methods. (telephone, internet, fax)
Reviewed and interpreted contractual terms for managed care, commercial, Medicare, Medicaid, and Workers' Compensation.
Contacted various payers and patients to collect outstanding accounts.
Tracked and entered all calls for documentation, trending, and reporting purposes.
Identified contractual and administrative adjustments.
Performed billing functions via electronic and hardcopy submission when necessary.
Ensured accuracy of account information and corrected any insurance data or patient registration discrepancies.
Obtained supporting documentation for insurance follow-up.
Reviewed and responded to insurance/patient corrections in a timely manner.
Identified billing issues and trends, reporting concerns or discrepancies to management promptly.
Composed correspondence, including claim forms, appeals, and notifications to applicable parties.
Assisted with special projects as needed.
Performed other duties as assigned.
Medical Collections
Integrated Oncology Network ION
March 2018--December 2020
Managed daily unpaid claims, ensuring claims were submitted within 48 hours of receipt.
Conducted extensive phone communication with third parties and medical groups.
Researched and resolved incorrect payments, EOB rejections, and outstanding account issues.
Ensured patient payments met collection objectives and minimized outstanding patient accounts.
Built and maintained relationships with insurance carriers.
Audited patient accounts, addressed patient inquiries, problems, and complaints, and provided solutions.
Screened and approved accounts for outside collections agencies.
Appealed claims as necessary according to contracts.
Maintained a strong Accounts Receivable (AR) for the company.
Corrected insurance data and patient registration errors.
Obtained supporting documentation for insurance follow-up.
Reviewed and promptly responded to insurance/patient corrections.
Identified and reported billing issues and trends to management.
Composed correspondence, including claim forms, appeals, and notifications to relevant parties.
Assisted with special projects and performed other assigned duties.
Timely submission of claims within 48 hours of receipt.
Proficient in timely filing regulations.
Efficiently post and reconcile insurance and patient payments.
Resolve payment discrepancies, EOB rejections, and account issues.
Maintain accuracy in insurance claims processing.
Utilize practice management software for electronic claims submission to clearinghouse.
Collaborate with clearinghouse to resolve claim-related problems..
Retrieve Electronic Remittance Advise (ERA's)
Assign ICD-9 codes for diagnosis review and proper CPT code assignment.
Send secondary claims after processing primary insurance.
Medical Assistant/Medical Collections
Saddleback Medical Group (Memorial Care)
September 2017–March 2018
Clinical Responsibilities:
Recorded vital signs and maintained accurate patient records, ensuring comprehensive medical documentation.
Provided valuable support to physicians during various medical procedures, including mole removal, injections, and other critical patient interventions.
Administrative Responsibilities:
Managed patient referrals, tracked progress, and ensured timely follow-up for improved patient care outcomes.
Efficiently scheduled patient appointments, showcasing strong organizational skills.
Skillfully managed financial aspects, including transaction posting and reversals, enhancing financial accuracy.
Contributed to revenue optimization by verifying patient eligibility and insurance coverage for streamlined billing.
Effective collaboration with insurance companies and medical groups, demonstrating excellent communication skills, and expediting claims reimbursement.
Financial Performance:
Consistently ensured strong quarterly accounts receivable (AR), bolstering financial stability and operational efficiency.
Collections/Claims Examiner
San Antonio Ambulatory Surgical Center
February 2006-May 2017
Managed daily unpaid claims, involving extensive phone contact with third-party carriers, workers' compensation insurers, and medical groups.
Submitted claims to appropriate insurance carriers for payment.
Investigated, rejected, and denied claims, and referred them for further information when necessary.
Built and maintained relationships with insurance carriers.
Managed patient payments to achieve collection objectives and minimize outstanding patient accounts.
Conducted audits of patient accounts, addressed inquiries, problems, complaints, and provided solutions.
Screened and approved accounts for external collections agencies.
Maintained a strong quarterly Accounts Receivable (AR) for the company.
Developed and trained supervisors, overseeing leadership and management of ASC collection functions.
Medical Assistant/Medical Collections
Dr. Mira B. Joshi MD-Upland
February 2001-May 2006
Recorded vital signs.
Assisted physicians with procedures, including mole removal and injections.
Managed patient referrals, tracked progress, scheduled appointments, and handled billing adjustments.
Verified patient eligibility and coverage.
Followed up on insurance claims and communicated with medical groups.
Maintained a strong quarterly Accounts Receivable (AR) for the company.
Enhanced revenue for all providers while managing the same patient load.
Ensured prompt claims entry and submission within a 48-hour timeframe.
Expert in adhering to timely filing regulations.
Proficiently managed insurance and patient payments reconciliation.
Successfully researched and resolved payment discrepancies, EOB rejections, and account issues.
Maintained high accuracy in processing insurance claims.
Utilized practice management software for electronic claims submission to clearinghouse.
Collaborated with clearinghouse to resolve claim-related challenges.
Proficient in retrieving Electronic Remittance Advise (ERA's).
Assigned ICD-9 codes for physician diagnoses and conducted record reviews for accurate CPT code assignment.
Managed secondary claim submissions following primary insurance processing.
Managed daily unpaid claims, engaging in frequent communication with third-party carriers and medical groups.
Achieved patient payment goals to minimize outstanding accounts and support collections objectives.
Cultivated and nurtured relationships with insurance carriers.
Conducted audits of patient accounts, addressed patient inquiries, resolved problems, and managed complaints while identifying effective solutions.
Approved accounts for external collections agencies as needed.
Maintained a strong accounts receivable (AR) performance for the company.
CONTACT
Phone
adzsn6@r.postjobfree.com
EDUCATION
Certification of Instruction; Medical Assisting
North West College
RELEVANT SKILLS
Bilingual (Spanish)
In-Depth Medical Terminology Knowledge
Proficient in HMOs, PPOs, Medicare, Medi-Cal, and Workers Compensation
Familiarity with Medical Manager Software
Comprehensive Understanding of Managed Care Contracts
Proficient in ICD-10, CPT, and HCPCS Coding
Trained in ASC Collecting
Adept at Ensuring HIPAA Compliance
Proficient in Medical Management Programs
AR
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