Medical Billing Revenue Cycle

Luis Cruz

Jupiter, FL *****

*************@*****.***

561-***-****

Work Experience

Patient Accounts Rep/ Biller

Coral Shores Behavioral Health Psychiatric Hospital-Stuart, FL November 2023 to Present

· Verification of all insurance benefits.

· Financial counseling of patients with balances and self-pay.

· Manage denials, appeals, and rejections.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Bill all claims Commercial, Medicare, and Managed Medicaid.

· Work A/R insurance and self-pay.

· Work on all EDI corrections.

· Work with the UR department to get the correct insurance information.

· Handle Single Case Agreements to get processed and paid. Billing Manager

Praesum Healthcare aka Sunrise Detox-West Palm Beach, FL September 2022 to August 2023

· In charge of 26 Detox and Residential facilities and 12 Counseling Centers.

· Managed and reviewed all New CPT codes and billing trends.

· Assist with work overflows such as EFT enrollments, billing, coding, and EDI. rejections, insurance verifications, and anything else the team needs help with.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Manage denials, appeals, and rejections.

· Credential new Doctors and ANRP providers for facilities and insurance carriers.

· Take the lead on new EMR software and clearing house program and implement staff training.

· Recruit, Hire, Onboard, Train, and Evaluate the performance of billing staff.

· In charge of staff payroll.

· In charge of all Single Case Agreements and getting them approved. Lead Biller

Palm Beach Cardiology Center-Palm Beach Gardens, FL October 2021 to September 2022

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Managed and reviewed all New CPT codes and billing trends.

· Assist with work overflows such as EFT enrollments, billing, coding, EDI rejections, insurance verifications, and anything else the team needs help with.

· Managed billing and collection department.

· UB04 and 1500 HCFA Billing and Coding.

· Denials, appeals, and rejections.

· Managed all aspects of the medical billing from provider credentialing, coding, and EDI rejections.

· Assist with billing issues with the Front desk with patients.

· Collect patient's unpaid balances.

· Train and evaluate the performance of billing staff.

· In charge of all Single Case Agreements and getting them approved. UR/AR Manager

Sun Medical Billing, LLC-West Palm Beach, FL

January 2019 to September 2021

· Managed all aspects of the medical billing across 4 facilities supervising 12 employees.

· Managed the Utilization Review process by establishing and maintaining efficient methods to ensure medical necessity and proper documentation.

· Managed and reviewed all New CPT codes and billing trends.

· Assist with work overflows such as EFT enrollments, billing, coding, EDI rejections, insurance verifications, and anything else the team needs help with.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Recruit, Hire, Onboard, Train, and Evaluate the performance of billing staff.

· In charge of all Single Case Agreements and getting them approved. Billing Director

Believe Treatment Center-West Palm Beach, FL

February 2018 to January 2019

· Managed all aspects of the medical billing from provider credentialing, coding, and EDI rejections.

· Managed the Utilization Review process by establishing and maintaining efficient methods to ensure medical necessity and proper documentation.

· Managed and reviewed all New CPT codes and billing trends.

· Assist with work overflows such as EFT enrollments, billing, coding, EDI rejections, insurance verifications, and anything else the team needs help with.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Recruit, Hire, Onboard, Train,

· and evaluate the performance of the billing staff. Revenue Cycle Manager

Life Recovery of the Palm Beaches-West Palm Beach, FL July 2017 to February 2018

· Managed all aspects of the medical billing from provider credentialing, coding, and EDI rejections.

· Managed the Utilization Review process by establishing and maintaining efficient methods to ensure medical necessity and proper documentation.

· Managed and reviewed all New CPT codes and billing trends.

· Assist with work overflow such as EFT enrollments, billing, coding, EDI rejections, insurance verifications, etc.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Recruit, Hire, Onboard, Train, and Evaluate the performance of billing staff.

· In charge of all Single Case Agreements and getting them approved Revenue Cycle Manager/Billing Director

Lumiere Detox Center-Jupiter, FL

March 2014 to July 2017

· Managed all aspects of the medical billing from provider credentialing, coding, and EDI rejections.

· Responsible for all UR calls

· Managed and reviewed all New CPT codes and billing trends.

· Assist with work overflows such as EFT enrollments, billing, coding, EDI rejections, insurance verifications, and anything else the team needs help with.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Recruit, Hire, Onboard, Train, and Evaluate the performance of billing staff.

· Responsible for all (IT) issues with computers and video cameras Billing Supervisor/Interim Collection Supervisor

Hyperion Billing Services -Delray Recovery Center-Boca Raton, FL July 2011 to March 2014

· Managed billing and collection department

· UB04 Billing and Coding

· Denials, appeals, and rejections.

· Research new diagnostic codes and billing trends.

· Managed office when the Director is out.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Managed and reviewed all New CPT codes and billing trends.

· Assist with work overflows such as EFT enrollments, billing, coding, EDI rejections, insurance verifications, and anything else the team needs help with.

· Compile and analyze financial reports and spreadsheets for executive meetings.

· Recruit, Hire, Onboard, Train, and Evaluate the performance of billing staff.

· Responsible for all (IT) issues with computers

Education

High School Diploma in Computer Programming, accounting Deer Park High School

August 1979 to June 1982

Skills

• Medical Billing (10+ years)

• Athena One Health (3 years)

• Microsoft Office- Intermediate (10+ years)

• Utilization Review (10+ years)

• Financial Statement Preparation (10+ years)

• Analytics (10+ years)

• Sunwave (5 years)

• Collaborate MD (10+ years)

• Kipu (10+ years)

• Medical Records (10+ years)

• Medicaid. (10+ years)

• Citrix (5 years)

• WAYSTAR (3 years)

• UB04 (10+ years)

• HIPAA (10+ years)

• Emdeon Vision (10+ years)

• Billing and Coding Certification (10+ years)

• Commercial Insurance (10+ years)

• Ability (5 years)

• Medicare (10+ years)

• Financial Report Writing (5 years)

• CPT-4, ICD-9 and ICD-10 Coding (10+ years)

• Waystar (3 years)

• Medic (10+ years)

• Accounts Receivable (10+ years)

• Medical Terminology (10+ years)

• EMR Systems (10+ years)

• 10e11 (3 years)

• eClinicalWorks (5 years)

• EKG Certified (10+ years)

• Medical Coding (10+ years)

• Cerner (5 years)

• Insurance Verification (10+ years)

• Hospital and Physician Billing (10+ years)

• Medisoft (10+ years)

• Lighting Step (3 years)

• Kareo Billing Software (3 years)

• Medical Scheduling (10+ years)

Certifications and Licenses

EKG Certification

December 1997 to Present

Driver's License

August 2021 to August 2030

Contact this candidate