Health Information Technology
Resume:
DHALIA VALLE
Neptune, NJ *****
EDUCATION
DeVry University, North Brunswick, NJ 6/2011
Associate in Applied Science in Health Information Technology
GPA – over 3.41
TECHNICAL SKILLS
Medical Terminology
Health Information Processes
Health Insurance and Reimbursement Methodologies
ICD-9-CM and ICD-10-CM CPT/HCPCS Coding
Pharmacology
Human Anatomy and Physiology
Pathophysiology
3M Encoder Software
SoftMed
Health Information Statistics
Microsoft Office Applications
Lotus Applications
Fourth Shift
Cerberus
ADP Applications
NASDAQ
OCS
GSCC
ACT System
Siemens (Ehim)
DocuManage/DocuRoute
Meditech
ADR
AS400 DOS System
Relay Health (Assurance Reimb. Epremis)
Eagle (MPI)
MPower (Med-Metrix)
HWC (Contract info. Retrieval)
Revenue Cycle Pro (Reference source for Coding, Billing, Reimb. And Compliance for Hospitals
NPPES NPI Registry
All Scripts
Medical Manager (MPI)
Cerner
Change Healthcare (claim rejections and billing)
Epaces
FMP
Jaguar Ambulance Billing
Coupa Portal (Invoicing)
PROFESSIONAL EXPERIENCE
Integra Connect, West Palm Beach, FL 02/2022-Present
A/R Facility Ambulance Billing Representative
Review and maintain 203 Facility Contracted and Non-Contracted Facilities, and send request for creation of New Contracts
Verify insurances for patient eligibility by using varies Entity’s Insurance Websites for Pt eligibility for all commercial and Government Entities
Maintain daily communication and correspondence with Facilities via phone, fax and or email
Review and maintain written correspondence from insurance, patient and or Facilities
Review and maintain trips previously written off, and or sent off to collections erroneously, by reversing and or pulling back from collection via excel spreadsheet
Review and facilitate transports due for refund to various entities such as patient, insurance and or facility
Review and maintain Ambulance Transports by correcting and sending off to insurance for rebilling within a timely fashion
Monitor and Review Ambulance Transports over 30, 60, 90 to 120 days and re-route according to processes set in place, insurance paid, insurance write off, patient and or for Facility Contract Billing
Review Ambulance Transports such as Inpatient/ DRG, Skilled Nursing Facility, Interrupted SNF Stay, Hospice, Correctional Facility and Payor of Last Resort, when compliant with Facility contracts trips are released for billing
Print invoices for Facility billing via PDF Adobe Files and or E-INVOICE Creation via Microsoft Excel
Monitor and Maintain invoiced trips billed to facilities, correct, rebill and when requested bill the patient
Review and follow up with billed Facilities invoiced Transports while following contract guidelines older than 30, 60, 90 and 120 days old, by compiling and emailing Aging Reports for payment statuses and or remittance information
Review, Maintain & update Reports with Deadlines for POLR (Payor of Last Resort) billing Projects
J&S Stark, Shrewsbury, NJ
10/2019-02/2022
A/R PATIENT ACCOUNTS REPRESENTATIVE-MEDICAL BILLING
Verify insurances for patient eligibility by using varies Entity’s Insurance Websites for Pt eligibility for all commercial and Government Entities
Review and maintain claims by correcting and rebilling within a timely fashion
Submit appeals to insurance carriers and maintain follow ups
Bill/Rebill and maintain Government Entity claims such as Medicaid and Medicare for Inpatient and Out-patient claims
Monitor and follow up on Commercial and Medicaid claims over 90 to 120 days for Inpatient and Out-patient claims
Maintain and update Microsoft Excel logs for correspondence between medical providers and billers
Maintain and update Medicaid Providers certified for Epaces RT billing
Maintain and enroll Medicaid Providers to Medicaid Epaces portal
Monitor and Maintain account adjustments such as No Auth. Denials, Denial Write Off’s, HCFA-Non-Contract Clinic (for Commercial claims), INCLUSIVE-claims that pay inclusive to another claim, Underpayments, and Untimely adjustments.
Med-Metrix, Tinton Falls, NJ
10/2017-9/20219
PATIENT ACCOUNTS REPRESENTATIVE-MEDICAL BILLING
Bill/Rebill and maintain Government Entity claims such as Medicaid for Inpatient and Out-patient claims
Keep track of hospital accounts balances due for payments
Monitor and follow up on Medicaid EOB’s, Medicaid Denials, & New Imports, both for Inpatient and Out-Patient claims
Monitor and follow up on Medicaid claims over 90 to 120 days for Inpatient and Out-patient claims
Monitor and maintain accounts with Medicaid over payments (Credits)
Bill and correct all Medicaid Inpatient and Out-Patient claims for Primary and Secondary billing
Monitor and Maintain account adjustments such as No Auth. Denials, Denial Write Off’s, HCFA-Non-Contract Clinic (for Commercial claims), INCLUSIVE-claims that pay inclusive to another claim, Underpayments, and Untimely adjustments.
Bill/Rebill OP Commercial claims, Follow up on OP Commercial claims status and Appeal commercial claims when necessary
Use varies Entity’s Insurance Websites for Pt eligibility and claim status such as EMEDNY (NY Medicaid), UHC, BC/BS, Navi-net, Oxford, Aetna Etc.
Rubin and Raine, Eatontown, NJ 11/2015 – 9/2017
BI-LINGUAL PATIENT ACCOUNT REPRESENTATIVE
Keep track of hospital accounts balances due for payments
Maintain accounts by verifying insurance eligibility and submitting claims to insurance for payments
Monitor unpaid accounts as well as contacting patients, 3rd parties such as workmen comp, auto insurance, no fault claims and attorneys’ offices to ensure payments
Maintain patients accounts by assisting in Spanish and English calls addressing concerns, answering insurance questions, and assisting patients by providing information such as charities that can assist in medical bill payments
Maintain self-pay accounts by contacting patients for p payment plans as well as processing payments
CentraState Medical Center, Freehold NJ 7/2011 – 11/2015
HIM ASSISTANT/ROI OFFICE ASSISTANT
Maintained keeping track of all Physician’s Delinquency Charts as well as sending Physician Suspension
Advisory notices and Suspending physicians who are delinquent in completing their charts while
Maintaining a current list of physicians currently suspended from all privileges
Assisted prepping ED Charts, MSU Charts, and IPT Charts in a timely and organized fashion
Analyzed Out-Patient Charts
Maintained and Corrected the Out-Patient Delinquency Report
Documented, Reported and Maintained Quality Control issues on ED Charts, MSU Charts, and IPT Charts
Tracked and Maintained “The Electronic Missing Documentation Validation Log” by tracking and reporting
Findings to proper personnel and work with resolving and locating documents for record completion
Managed and Maintained the ADR (Auto Document Routing for The Apple-Wood, The Manor, & Monmouth Crossing) system
In which physician’s use to Dictate Reports such as Consults, H & P’s, Operative Reports, and Discharge
Summaries, the reports are then transcribed and ADR to patient accounts
Release of Information following hospital policies and procedures in conjunction with HIPAA, State Rules and regulations to healthcare facilities, attorneys, DYFUS, Disability, Workers’ Comp., Subpoenas, Court orders, patient request, Healthcare Insurance co. for payments and 3rd Party requesters
ADDITIONAL INFORMATION
Bilingual, fluent in English and Spanish
Professional Member, American Health Information Management Association
Professional Member, New Jersey Health Information Management Association
Completed 80 hours practicum at CentraState Medical Center in Freehold NJ
Experience in Customer Service since 1997
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