Medical Billing Behavioral Health
Resume:
Maria O. Park
Scottsdale, AZ ***** **********@*****.***
QUALIFICATIONS
•Expert in medical terminology and legal Terminology, ICD 10 HCPCS Coding
•Experienced in all medical insurance Carriers Including Mco’s
•Proficient in Microsoft Office Suite 2007; fluent in Spanish; type at 45 w.p.m.
•Manage multiple task when required/maintain confidentiality at all times
•Understand and work within all AMA Guidelines and maintain compliance requirement
•Skilled in Hboc, Meditech, Epic, NextGen, NPPES, Nebo-thin, Florida Shared, I-DX Primes, Medical Management, CMS AS400, Edamt, Lytec, Medisoft, Allegra, Centricity, Health Review Management, Active-Dash and Cerner, NGS Connex, Medical Practice, Availity and NaviNet, E-care, HFS, Mco’s Portal, Chase and US Bank Portal, One source, Medistrings. Quick Cap 7, Profiler, Banner, Arizona Complete Portal, Health Blue Cross of Arizona, Brightree, Mercy Care/RBHA, EverNorth Healthcare, AHCCCS, Ameriben, Cigna/Health Alliance, Magellan, Molina, Thru-Availity, SPSI, and Credible Medical software, Wellsky, Waystart Clearing House, Interactant, Ring Central, S-fax. Alias, Echo’s Mimecast for authorizations, Change Health Connect, SSI, Kipu-EMR, NextGen, Blue cross blue Choice, Payspan, Collaborated MD, Noridian.
PROFESSSIONAL EXPERIENCE
Masis Staffing Solutions/Crossroads, Inc. Behavioral Health Phoenix, Arizona
Medical biller/Denial/Specialist-Behavioral Health March 2025 – June 2025
Worked on aging A/R Reports
Reviewed, rebilled and appealed all denial of claims involving AHCCC’S, Banner, UHC, AHC, BC/BS of Arizona, BC/BS Choice, AIHP, Availity Portal, and Oscar Health
Handled Special projects including resolving unpaid Mercy Care claims
Corrected BOX 19 NPI on SSI Portal and Collaborated MD.
Verified eligibility
Reviewed Medial Record through NextGen EMR for proper coding and billing.
Posted payments
Trained colleagues and managers on billing procedures, coding and portals issues.
Solterra Management Group/Bridgewater Assisting Living Co. Scottsdale, Arizona
Administrator-Lead-Biller for Medicaid/Accounts Receivable. January 2024-2025
Bill monthly claims for 6 locations with ALTCS, through various medical portals: UHC, Banner and Mercy Care
Review claims with proper ICD-10 and Modifiers – for billing with case managers
Post payments; work on denials and appeals; follow-up on unpaid claims, correct and rebill claims
Obtain monthly authorizations for new/old residents; check eligibility through AHCCCS for residents
Run reports for aging accounts as well as move in and out of residents; set room and board calculations for new residents; and send out private resident statements
Work with Controller to credit accounts and handle recoupment issues
Work on special projects for CEO and Controller; handle provider inquiries
Trained new employees and managers on billing procedures, coding and portals issues.
The Intersect Group/ Devereux Advanced Behavioral Health Phoenix, Arizona
Accounts Receivable Rep. May 2023 – June 2023
•Handled Aging reports for old and new accounts through Excel spreadsheets for various payers
•Checked pending behavior health claims for verifying status of payment and rebilling
•Corrected claims for rebilling, including entering school district codes
•Submitted accounts for adjustment.
Addison Search Group/BrightSpring Health Services. Phoenix, Arizona
Revenue Cycle Coordinator Rep. March 2023 – May 2023
•Worked on daily E-mail correspondences for the Billing Dept.
•Prepared appeal letters, subpoena letters, and MVA
•Organized and submitted Medical Records requested by Carriers to support claims
•Billed medical and MVA claims.
Robert Half International Staffing/Open Hearts Family Wellness-Behavioral Health Phoenix, Arizona
Account Receivable Representative September 2022 – January 2023
Follow up with unpaid behavioral health accounts for various payers.
•Corrected claims denial and under paid accounts rebilled when necessary
•Review accounts when insurance denied claims due to coding or other billing issues
•Submit appeals along with insurance request such as M/R attachments
•Handle CHBSF special accounts and verified monthly eligibility for DOS
•Check payments daily through insurance portals, and send EOB’s if claim was paid and processed to the posting department via E-mail by PDF.
Ajilon Professional Staffing/Devereux Advanced Behavioral Health Phoenix, Arizona
Special Projects Assistant for Accounts Receivable April 2021 – June 2022
•Verify status of claims on UHC, Arizona Complete Health, and Banner portals
•Work on aging account reports on Excel spreadsheets
•Prepare write-offs and adjust the same on the Profiler System
•Handle various special projects requested by the Manager.
•Handle Credit and refunds reports Via Spreadsheet.
Robert Half Office Team/Swedish Covenant Physician Group Chicago, Illinois
Special Project Representative-Claims Adjudicator Nov. 2019 – March 2020
•Processed all BCBS and Humana physician claims for payment and capitation, including laboratory ambulatory, psychotherapy, nursing skill and related charges
•Assisted the Director on special projects, including based on spreadsheets for NPI or Tax ID’s on claim entries
•Assisted coders with medical records requests or other projects as needed, and sort and distribute all daily correspondence.
Addison Search Group/Rush Physician Billing Chicago, Illinois
Special Project Representative July 2019 – Nov. 2019
•Evaluated incoming mail from insurance carriers, including identifying their purpose, replying to their inquiries or forwarding the mail to colleagues or collectors for further handling
•Handled all communications with insurance carriers through Medistrings portal
•Submitted EOB’s, claims, medical records and provider W-9’s to insurance carriers and followed-up on status of claims, enter Medical Bankruptcy Correspondence information
•Handled Aetna, Cigna, Jessie Brown, Edwards Hines Veterans Affairs WQ
•Adjusted balances and credit card payments; prepared refunds for management approval; followed up on self-pays; and contacted credit card companies to opt out
•Review EOB’S for batching for patients, send out weekly reports to management re: correspondence,
•Handled special projects as assigned by the managers.
Addison Search Group/Swedish Covenant Hospital Chicago, Illinois
Special Project Representative Nov. 2018 – March 2019
•Work with IDPA denial vouchers and with excel spreadsheets provided daily by the Manager for special project of aging accounts
•Correct claims on CMS for denial codes such as DNC or 36415 or R02 or R03;
•Add modifier to claims when needed and re-billed, send out UB04, 2360 override for system issues updated or follow up with prior appeals
•Check eligibility on One source updated information to bill correct payers for MCOs, generated self pay letters for R06 Spend down unmet.
Addison Search Group/Ann & Robert H. Lurie Children’s Hospital Chicago, Illinois Public Aid Biller & Collector/Customer Service Support Jan. 2016-Mar. 2017; Aug. 2017- Nov. 2018
•Follow-up on denials, correct and re-bill to Public Aid and DME Authorizations, and on overlapping accounts, submit to proper facility with EAP along with expected Reimbursement letter
•Bill on UB04 override or 1500 or 2360 form for erroneous denials
•Call IDPA when necessary regarding Gender issues, work on special project when assigned by Manager
•Daily Duties: handle all insurance carrier authorization correspondence and entries in Epic
•Responsible for submitting medical records to appropriate insurance as requested
•Verified Eligibility when is needed in NDAS to bill claim for all Carriers
•Handled daily report of change of address updated system
•Contacted patients when credit card is declined and reprocess once information if corrected
•Handled Bankruptcy letters and adjust account and Special Projects as requested by Manager
•Answered daily call from patient inquiry on balance set plan arrangement and settlement
•Searched and resolved credit balance over payment by insurance or Patient compile all information such as EOB, or patient check/Visa to begin process of refund
•Handled financial assistant by gathering all information provided by patient’s parents.
Ajilon Professional Staffing/Erie Family Health Center Chicago, Illinois
Biller/Primary and Secondary Carriers March 2017 - August 2017
•Submit non-EDI primary and secondary/tertiary claim according to recognized practice standards
•Bill for four Major Hospitals via Centricity or HFS
•Contact insurance carriers to determine extent of coverage, claims filing requirements and claims status through web portals
•Handle special projects, including VFC, mammogram Programs, and Hedis for FQCH Providers
•Check eligibility for Mco’s and public aid accounts and updated system with information
•Process claims in timely and efficient manner for inpatient and outpatient services
•Review A/R account aging with emphasis on resolution within 45-90 days
•Assess uncollectable accounts and adjust, according to department protocols.
Addison Search Group/Ann & Robert H. Lurie Children’s Hospital Chicago, Illinois
Collector/Customer Service Support January 2016 - March 2017
•Daily Duties: handled all insurance carrier authorization correspondence and entries in Epic
•Responsible for submitting medical records to appropriate insurance as requested
•Verified Eligibility when is needed in NDAS to bill claim for all Carriers
•Handled daily report of change of address updated system
•Contacted patients when credit card is declined and reprocess once information if corrected
•Handled Bankruptcy letters and adjust account and Special Projects as requested my Manager
•Answered daily call from patient inquiry on balance set plan arrangement and settlement
•Searched and resolved credit balance over payment by insurance or Patient compile all information such as EOB, or patient check/Visa to begin process of refund
•Handled financial assistant by gathering all information provided by patient parents.
Wolcott Wood And Taylor UIC Physician Group Chicago, Illinois
Medicaid Biller September 2015 - December 2015
•Handled Medicaid Work Queue, follow up on Denials Via HFS Nips status
R01, R03, R36, D05, X06, R02, C16 Requests, C17, T721, C33
•Corrected/submit claims with Such Medical Records or information needed on claim
•Updated insurance information in Epic system. Also checked spend-down • Checked Illinois IDPA website for Proper procedure reimbursements
•Handle all Spanish Speaking call patients Balance Inquiries.
Rehabilitation Institute of Chicago Chicago, Illinois
Secondary Biller/Credential Specialist February 2014 - June 2015
•Managed daily report for secondary billing to Medicare and Commercial carriers
•Responsible for submitting medical records to appropriate insurance as requested
•Resolved and refunded insurance over payments, including Patients
•Handled a daily report for doctor NPI Credentials
•Handled daily MCRB sequestrations adjustment and GK modifiers
•Worked on spreadsheet daily for accounts aged over 90 to 181 days
•Followed-up on secondary claims for appropriate payer reimbursements
•Analyzed all aspects of claims submissions to appropriate payers.
Norwegian American Hospital Chicago, Illinois
Biller/Follow-Up Representative July 2012 - February 2014
• Managed reports for claims previously submitted
•Responsible for accurately billing all commercial carriers
•Resolved financial discrepancies on all fiscal records
•Maintained strict patient confidentiality through HIPPA
•Handled insurance claims electronically and manually
•Actively monitored credit balances to ensure compliance with Federal and State regulatory requirements
•Followed-up on 90 to 181 days aging reports
•Followed-up on claims for appropriate payer reimbursements
•Analyzed all aspects of claims submissions to appropriate payers.
CERTIFICATIONS AND EDUCATION
Medicare University
Chicago, Illinois
Earned 18 Certificates through Webinar Sessions
2017
AMS Medical Billing School
Chicago, Illinois
Concentration: Medical Billing Specialist
Certified: 11/06 To 06/07
Moraine Valley Community College
Chicago, Illinois
Concentration: Medical Terminology
Certified: 01/06 To 05/06
Tech Soft Services Vocational School
Chicago, Illinois
Concentration: Administrator Assistant Certified: 05/08 To 08/08
Northwestern Business College Chicago, Illinois
Concentration: Business Administration 09/01 To 03/02
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