Billing & Credentialing Specialist (Healthcare)
Resume:
Michelle Lourenco
Long Beach, CA *****
**********@*****.***
Professional Summary
To secure a challenging position that utilizes my skills, education and provides professional growth. Authorized to work in the US for any employer
Authorized to work in the US for any employer
Work Experience
Billing and Credentialing Specialist
Community Medicine Inc-Bellflower, CA
February 2025 to Present
• oversee billing department compliance wit FQHC guidelines Credentialed all providers including mid-levels with major health plans and IPA’s Oversee the front desk staff and process all the end of day posting. take any escalations regarding billing or credentialing Post payments for capitation and wrap-around
Billing Coordinator
Bloch Wellness Chiropractic and Sports Medicine-Long Beach, CA June 2024 to Present
Communicate with third party billing company to ensure timelines of claim submission and follow up. Monitored response time for denials.
Handled all authorizations and coordinated treatment with adjusters for workers compensation cases for city and county first responders.
Handled all personal injury cases from communication with council to negotiation of payments. Lead Medical Billing Specialist
Skin and Cancer Institute-Cerritos, CA
August 2023 to May 2024
Scrub, verify CPT codes and process unbilled claims electronically and paper. Bill claims to secondary insurance with requested documentation. Work all denied claims for 8 busy clinics.
Correct CPT codes and add modifiers for re-billing of insurance claims. Follow up with payers for payment of claims.
Process reconsiderations, 1st and 2nd level Appeals. Post payments, make adjustments and write off’s as necessary. 2 months in Credentialing physicians with commercial, private and government payers. Lead a team of 12 billers. Sr. Biller/Collector
Prime Healthcare/ West Anaheim Medical Center-Anaheim, CA March 2023 to August 2023
Verify patient demographics and eligibility
Determine who is at risk for claim based on inpatient and outpatient procedures using DOFR. Follow up on denied claims and file reconsiderations, Appeals and Grievances as needed. Ensure posting of payments are made in a timely manner.
Credentialing Coordinator
The Oncology Institute of Hope and Innovation-Cerritos, CA October 2021 to October 2022
organize, maintain, and verify all aspects of the process, and maintain current files on practitioners. You will track the expiration of certifications to maintain up-to-date files. Apply for privileges at hospitals and provide them with documentation necessary to verify credentials. Submit applications to insurance companies and medical groups and follow up regularly. Small Group Contracting
United HealthCare Services, Inc-Cypress, CA
August 2020 to March 2021
Building contracts for small group employers with attention to detail. Verifying rates for HMO Plans and building a contract based on the type of plan(s) the employers offer their employees. This was a contract job for six months.
Billing Specialist
Straight Talk Clinic, Inc.-Santa Ana, CA
July 2018 to March 2020
Established revenue cycle management and insurance billing for Behavioral Health for 10 Therapists. Responsible for all insurance claims, follow ups and denials. Worked payment reports and posted payments for insurance and self-pay clients. Performed many administrative and accounting duties for non-profit organization. Maintained budget and billing for sober living home funded by the County of Orange. Did all case management billing for Drug Med-Cal. Collector
Designed Receivable Solutions-La Palma, CA
January 2012 to March 2018
Maintained patient account balances based on required time frames. Managed delinquent accounts initiating collection procedures as required. Advised in resolution of customer billing issues through typical inquiries. Worked with customers to establish patient payment plans. Gathered medical records to input and update patient information in computer system Ensured medical collection activity was conducted as per company local and state guidelines. Reported patient and payer credit balances on monthly basis. Outbound dialer on a daily basis.
Billing Clerk
Healthpointe Medical Group-La Mirada, CA
September 2009 to January 2012
Responsibilities include patient account follow up and collections, insurance claim follow-up, rejection/ denials, filing appeals, claim submission, contractual issues. Knowledge of worker's compensation claims. Ensured medical collection activity was conducted as per company, federal and state guidelines. Maintained records in an organized manner, corrected and re-billed denied claims when necessary, and performed secondary billing.
Education
Medical Billing & Coding (Certificate)
ABC Adult School-Cerritos, CA
January 2008 to December 2009
High school diploma or GED
Skills
• Lean
• NextGen
• Mentoring
• Documentation review
• EMR Systems
• Insurance medical billing
• Medical records
• Data entry
• Organizational skills
• Front desk
• Accounts receivable management
• Insurance Verification
• Budgeting
• HCPCS
• Health insurance
• Office management
• Workers' Compensation
• Adobe Acrobat
• Windows
• QuickBooks
• Cash handling
• Fiscal management
• Leadership
• Team management
• Clerical experience
• Attention to detail
• HIPAA
• Word processing
• Google Workspace
• Healthcare management
• Dental office experience
• Office experience
• Zendesk
• Microsoft Outlook (10+ years)
• Contracts
• Medical terminology
• Administrative experience
• ICD-9
• Microsoft Office
• Communication skills
• Management
• ICD coding
• 10 key typing
• Hospital experience
• Epic
• Medical coding
• Supervising experience
• Medical billing
• Customer service
• HIPAA compliance
• Relationship management
• SharePoint
• Patient care
• Accounts receivable
• EDI
• Pivot tables
• Managed care
• Medicare
• SQL
• Phone Etiquette
• Typing
• 10 key calculator (10+ years)
• Anatomy Knowledge
• Medical office management
• Computer literacy
• Cash register
• Revenue cycle management
• ICD-10
• Account management
• Case Management
• Home health
• Medical Collection
• Transcription
• Time management
• Accounting
• Basic math
• Customer support
• Financial report interpretation
• Research
• Analysis skills
• Clinic experience
• Healthcare practice team management
• Outpatient
• CPT Coding
• Accounts payable management
• Medical management
Languages
• English - Fluent
• Portuguese - Fluent
Certifications and Licenses
Certified Coding Specialist
Certified Provider Credentialing Specialist
Certified Professional Coder
Medical Billing Certification
Medical Coding Certification
Driver's License
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