Patient Account & Insurance Coordinator Resume

Ebony Raygoza

Cell 760-***-****

Email: ************@*****.***

Victorville Ca 92392

Experience:

Desert Valley Hospital Victorville ca 7/25/25-current Patient Account Registrar:

● Interviews patients to obtain demographics

● Secure insurance information, eligibility, benefits and authorizations

● Medi tech

● Ability to communicate with adolescents, young adults,middle adults and pediatrics

● Making sure all consents and forms are signed by patients

● Proficiency in medical terminology and ability to multitask Shiloh medical center Victorville ca 1/9/25-4/2025 Referral Coordinator:

● Submitting authorizations to different specialists such as cardiologist, neurologist, podiatrist, pulmonologist

● Working with HMO insurances: IEhp, choice & horizon valley

● Scheduling patients

● Assist patients with questions regarding labs,referrals and prescriptions

● Allscripts and EHR

● Checking insurance eligibility with all health plans

● Sending messages to providers for patients requests on Labs and medication Prospect Medical Group Orange ca 10/2023-7/2024

Customer Service:

● Provide claim and appeal information

● Answer high incoming calls 60+ and above

● ICD-10/CPT coding, HMO/PPO.

● Followed Medicare/CMS billing guidelines when reviewing claims

● Proving all necessary information of common Working File and Medicare Secondary Payer for accuracy

● Reviews denial EOBs to ensure prompt follow-up on denied services and submits appeals as needed.

● Working with insurance companies and physicians offices to complete insurance authorizations Optum Care Network Ontario ca 10/2022-9/2023

Member Outreach:

● Answer high incoming calls in a professional and courteous voice.

● Transfer calls to other departments.

● Intermediate skills in Microsoft Word and Excel.

● Reviews emails in a timely manner.

● Verify insurance eligibility and coverage

● Conduct a preventive outreach to keep members on top of their health

● Handle authorizations & referrals so members have access to care they need

● Discretion in handling confidential information and patient medical records. Gracelight Home Health Victorville ca 7/2022-10/2022 Referral Coordinator:

● ICD10, hcpcs & cpt coding

● Microsoft office

● Complete referrals for clinic and facility processed effectively

● Keep patients up to date with the status of referrals Scheduling hospice providers for input, output, physical therapy And occupational therapy

Network Medical Management Alhambra ca 07/2020

Claims analysts:

● Reviewing insurance claims filed by policy holders to ensure they are accurate and complete, that the individual understands their benefits and that the polices cover the claims

California Business Bureau Monrovia Ca 10/2019-05/2020 Medical Billing:

● Ezcap, ICD-10/CPT coding, HMO/PPO.

● Followed Medicare/CMS billing guidelines when editing and submitting claims as assigned. Responsible for reviewing, correcting, and completing UB04 forms and sending all necessary information and documents to government payers.

● Review and complete billing reports such as: late charge, overlapping, adjustment, and credit balance reports.

● Reviews the Common Working File and Medicare Secondary Payer for accuracy,forwards errors to facility for correction/verification.

● Monitors the ABN for outpatient procedures. Reviews Denial Management report daily to ensure prompt follow-up on denied services and submits appeals as needed. SuperCare Health City Of Industry Ca 06/2018-10/2019 Customer Service Representative:

● Scheduling senior patients for oxygen equipment and Resupply; Ventilators, CPAP/Bi-Pap, Wheelchairs, Hospital Beds, Patient Aids, Suction Pumps, and Nebulizer.

● Provide ETA, work with dispatch delivery oxygen equipment

● Ability to organize and prioritize work and complete projects under tight deadlines.

● Multi-tasking.

Education: Youthbuild Charter High School - El Monte 06/2017 UEI College - El Monte 06/2018- Medical Billing and Coding

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