Specialist Ii Los Angeles
Resume:
AMADA MARQUEZ
CONTACT SUMMARY
*************@*****.***
Stanton, CA
Highly motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised
and quickly mastering new skills.
SKILLS EXPERIENCE
• Excel, Microsoft Word, 10
key by touch, EPremis,
Artiva, ACE, EPIC, CITRIX
System, Cisco Systems,
NTHRIVE, FMS, Medical
POS
• Device, Internet, Soft
Med, IDX system, Cerner,
Paragon system, MDX,
PBAR, Health logics.
• Mature, Ambitious,
Friendly, Punctual
• Fluent in Spanish (Read,
Write, & translate)
ACCOUNT RESOULTION SPECIALIST II 02/2024 to 11/2024 CURRENCE HEALTHCARE Robert Half Staffing – Los Angeles, CA
• Accounts Receivables Management at Maui Health
Systems
• Follows up on initial claim status via phone and web portals.
• Clarifies underpaid accounts for clarification.
• Reviews correspondence for denials, authorizations, and other related matters.
• Itemizes bills, files reconsiderations, and appeals.
• Reviews EPIC and Artiva systems for notes.
• Submits adjustments for supervisor review.
• Provides daily Shift Briefing for accounts not paid exceeding 120 days.
• Conducts weekly quality audits on collectors, my score was 98%.
MEDICAL BILLING ASSOCIATE 10/2023 to 11/2023
SOUTHLAND MEDICAL GROUP Robert Half Staffing - Lakewood, CA
• Maintained patient records, verifying accuracy and completeness of data entered the system.
• Assisted in resolving discrepancies between bills and insurance companies.
• Medical office billing for Nephrologist medical group gathers and match information on two systems, pull and attach progress notes to pertaining health plan that requires med records and verify insurance eligibility and
authorizations and assist on ESRD billing.
EDUCATION
• Santa Ana Valley High
School - Santa Ana, Ca
Diploma
• Santa Ana College -
Santa Ana, Ca
INSURANCE CLAIMS ADJUSTER 02/2023 to 07/2023
Electronic Waveform Lab, Inc. - Huntington Beach, CA
• Review and process work comp claims from high incoming emails from various vendors consist of prescriptions and correspondence and respond to required information being requested from the vendors
• Interpreted medical records and legal documents related to insurance claims.
PATIENT ACCOUNT REP 12/2021 to 09/2022
Conifer Health Solutions - Frisco, TX
• Remote work from home responsible of managed care and commercial receivables (all insurance plans) make
outgoing calls insurance companies for follow-up on unpaid and appeal accounts, review for adjustments handle all my assign accounts via worklist identified as underpaid thru correspondence and delegate for underpaid review, dollar range review from low dollar to high dollar, while on hold, handle (hold accts) work on small dollar accounts for adjustment review and review EOB’s.
ACCOUNT SPECIALIST 03/2020 to 03/2021
Kali P. Chaudhuri Owner Healthcare - Santa Ana, CA
• Developed and maintained customer accounts by
accurately recording customer information.
• Analyzed financial data to identify discrepancies in account balances and ensure accuracy of records.
• Collaborated with other departments to resolve problems related to customer accounts.
PATIENT ACCOUNT REP 08/2018 to 03/2021
Mednax Health Partner Solutions - Orange, CA
• Low/med dollar collector, responsible of managed care and commercial receivables (all insurance plans) review for adjustments handle all my assigned accounts via worklist identified as under paid, work correspondence appeal accounts identified as underpaid tale credit and payments. ACCOUNTS SPECIALIST 12/2004 TO 10/2015
Tenet Healthcare Systems - (12/2004-03/2005)
Western Medical Center - (03/2005-06/2015)
Integrated Healthcare Holding Inc/ KPC - (06/2015-10/2015)
- Santa Ana, CA
• Managed customer accounts • and updated
records as needed.
• Collaborated with other departments to resolve any discrepancies in billing data or documentation.
• Provided customer service and support to patients regarding billing questions and issues.
• Performed follow-up actions on overdue accounts
according to established procedures.
• Maintained a database of customer contact
information for communication purposes.
• Researched and resolved customer inquiries
regarding billing issues or payment disputes.
Medium dollar collector, responsible of managed care and commercial receivables (all insurance plans) work comp accounts, review for adjustments, handle all my assigned accts via worklist reports, review correspondence high volume daily, assist on all walk ins, appeal on accounts identified as underpaid, handle self-pay accts, take credit card payments over the phone and walk ins, In 2005 assist @ Western Med Center Anaheim (admitting dept Transfer for 5 months due to conversion) assist in areas of registration, OP surgery scheduling, ER Dept, when down time handle manual registration, notate all accounts in detail, follow up all accts via website/ calls determine financial responsibility, analyze accounts in detail, send rebills, review EOB, determine if accounts need to be netted down and reclass accounts properly.
PATIENTS ACCOUNT SPECIALIST 10/2001 to 11/2004
Tenet Health Systems CBO - Westminster, Ca
• Responsible for managed care and commercial collections, billing and appeals on patient accounts.
• Trouble shooting accounts and identifying. underpayments or adjustments due to system calculations.
• Insurance follow up
• Preparation and resolution of managed care insurance claims, including but not limited to: claims follow up, billing care/ IPA/MG/HP risk pool relationships, as it pertains to billing, reimbursement calculation, liability and contract interpretation.
PATIENT ACCOUNT COUNSELOR 06/1999 to 09/2001
Children's Hospital Orange County - Santa Ana, Ca
• High dollar collector, handle all Aetna, PacifiCare patient accounts also handled other health plans, check on claim status online website or phone, submit high dollar adjustments, do refund request patient and or insurance co; take high volume of phone calls insurance and patient, self- pay accts input insurance into systems, collect on self-pay, offer discount to parents on the phone or walk in, run POS online or thru machine reserve share of cost, check for correct reimbursement in contract book, do stop loss calculations, Appeals, follow up on over $10k accounts on a report, age report, work correspondence, both for
insurance and parents.
• Denials, assist parents on the phone or walk ins request for medical records, set up payments plan / monthly, adjust accounts to correct balance, take credit card
payments over the phone or walk ins (multiple accounts) send out letters to parents, help on Reconciliation payments, pull UB-92, Itemize bill, fax claims to health plan, IPA send claim certified or Fed Express, all accounts well documented.
ADMITTING COUNSELOR 03/1999 to 09/2001
Santa Ana Hospital - Santa Ana, Ca
• Graveyard shift, register patients for urgent care, OB/GYN, run census report, distribute to various departments, have patients fill out necessary documents, run Medical online or thru.\
• POS machine, assist in other shifts when needed, take payments drop in safe, Pre-register for
• Labor and Delivery.
COLLECTOR 03/1991 to 06/1999
CCB Centralized Credit Bureau / National Recovery Center, National Medical Enterprises,
Office Systems - Santa Ana, Ca
• Handle all account receivables for numerous facilities, hard core collections, heavy phone line automated line, run TRW reports on accounts being prepared for Legal referral take payments over the phone credit cards, assist patients for financial assistance, predictive dialing system.
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