Authorization & Billing Specialist

Janice Aviles

Phone: 254-***-**** Email: **********@*****.***

Relevant work experience

Authorization Specialist AxisCare Waco, TX 01/2026 - Present Hours per week: 40

Process VA billing claims, ensuring accurate and compliant submissions. Review claims for completeness and adherence to VA billing standards, identifying discrepancies for prompt resolution. Monitor claim rejections and denials, investigate root causes, and perform necessary corrections.

Conduct regular follow-up on outstanding claims to ensure timely reimbursement. Client and Team Collaboration

Collaborate with Client Success

Managers and other billing team members to address client billing inquiries and troubleshoot issues. Provide updates and relevant claim information to clients, supporting efficient communication and fostering positive client relations.

Compliance and Documentation

Maintain up-to-date knowledge of VA billing requirements and implement changes as needed to comply with regulatory standards.

Ensure accurate documentation and tracking of all billing activity, maintaining detailed records for reporting and audits. Put authorizations for Veterans utilizing home health care through the VA’s community care program. Making sure authorizations are complete and accurate.

Distribution Center Administrator Coca Cola SWB Waco, TX 05/2025 - 01/2026 Hours per week: 40

SALES SUPPORT: Phone/Reception. Enter call in orders/hotshots (immediate orders). Copying, laminating and distributing. RS02 file maintenance (driver datea in route accounting system). Coupon tracking. Create and maintain Track/Rank/Publish boards as required. Sales Meeting Notices/Handouts as requested ACCOUNTS RECEIVABLE/CREDIT: Customer Accounts Receivable research. Sales Center Charge back, Customer mail check requests (validation). NSF Review and tracking – notification to sales. PIA, drafting credit memos and invoice corrections. Local Branch Deductions research.

HUMAN RESOURCES: New Employee Orientation and On-Boarding. Responsible for collection, review and dissemination of original new hire paperwork. Serves as local Chain of Custody Coordinator for Drug Test Program. Prints and posts Open Requisition reports/Job Opportunity listings. Make sure all required postings are posted (for audit purposes), DOT – files, random drug testing, records of violation, MVR and physical re-certification. Safety Matrix – Training, tracking, and reporting to responsible parties PAYROLL: Process and transmit weekly payroll within time deadlines and audit requirements including proper approvals. Process payroll adjustments, uniform deductions, miscellaneous deductions. Maintain and update LCC codes/ hour transfers in timekeeping system. Ensure that all approvals are obtained to process payroll. Monitor Kronos

(timekeeping) and payroll activities. Remote punch audit tracking to ensure compliance with audit frequency. Trimester Incentive verification as requested for route assignments and other required information SECURITY. Security door†maintenance and programming. Maintain surveillance back up tapes. Maintain visitor log and badges. Assign access cards.

Information Technology: Phone system and voice mail maintenance. Maintain/request maintenance on office equipment.â€

MISCELLANEOUS ADMINISTRATIVE DUTIES: Coordinate employee/facility events including catering and meeting room set up. Handle mail/shipping. Update phone directory. Ensure compliance to company audit guidelines. Manage flow of information throughout the day, faxes, copying, telephone, etc. Schedule conference rooms. Support inventory process as assigned. Provide admin support to Sales Center Manager and other leaders as assigned. Contact Representative Department of Veterans Affairs Waco, TX Grade: 7

01/2011 - 09/2025

Hours per week: 40

I am part of the OJT team which is a mentoring program. Whenever there is a new class of trainees one is assigned to me and I make sure they are doing their job as it was taught in training class. Responds to questions and concerns and resolving administrative pharmacy and billing activities. Answers calls involving a broad range of topics, including: tracks status of Rx, educates veteran in obtaining refill, and provides appointment information.

Updates master record with insurance information (adding or removing) Process payments

Assist with options for financial hardships

Compose detailed case notes when actions are affected. Develops referrals and documents case activity for action by facility to include a wide range of topics

*Receives telephone calls from and/or generates telephone calls to Veterans, their family members, and/or legal representatives concerning billing inquiries. *Responds to Veterans questions and concerns, researches, identifies, and resolves complex billing issues. *Receives telephone calls from and provides information to the public about a variety of VA and related non-VA benefits available to Veterans, their dependents, and beneficiaries. *Asks clarifying questions ensure that the primary issue of the caller is identified and to identify any other concerns and issues that may or may not be related. *Determines the most appropriate action or identifies alternatives in resolving issues thru in-depth research, interpretation, and analysis of master record information contained within the Veterans Health Information Systems and Technology Architecture (VISTA), Computerized Patient Record System (CPRS), Consolidated Copayment Processing Center

(CCPC), Enrollment System Redesign (ESR), Consolidated Mail Outpatient Pharmacy (CMOP), Customer Relationship Management (CRM) systems and several other resources and guidelines. *Reviews, updates, and edits master record information contained within the Veterans Health Information Systems and Technology Architecture (VISTA) system and within the Enrollment System Redesign (ESR) system. I am part of the OJT team which is a mentoring program. Whenever there is a new class of trainees one is assigned to me and I make sure they are doing their job as it was taught in training class. Responds to questions and concerns and resolving administrative pharmacy activities. Answers calls involving a broad range of topics, including: tracks status of Rx, educates veteran in obtaining refill, and provides appointment information. Compose detailed case notes when actions are affected. Develops referrals and documents case activity for action by facility to include a wide range of topics such as; Rx in pending status more than three (3) days, Place Rx in ``Hold'' status, Remove Rx from ``Hold'' status, Cancel Rxs due to Veteran's Death, Rx filled to window, Veteran requests that it be mailed; incorrect Quantity of Medication Sent, and Medication damaged in the mail. Serves as mentor and aids in training entry- level representatives on call center procedures and other job requirements. Sends correspondence, reviews, updates and edits master record information. Provides information on Returned Medication policy. Monitors recorded and/or live calls to determine efficiencies and training needs of staff; Evaluates workload distribution and provides supervisor with recommendations to balance accordingly; Responds to questions and resolves issues without involvement of a supervisor, unless necessary; Assists lower graded staff in providing customer service function to Veterans, Veteran family members and/or representatives, the public, and VA employees; Participates in delivery of on-the-job training for new staff; Works with supervisor in redistributing workloads to meet unusual deadlines and priorities; Maintains current knowledge of subject matter within assigned functional area; Participates in the handling of escalated calls; Provides clarification of standard operating procedures upon request and when personal observations indicate clarification may be appropriate; Coaches staff in achieving performance standards and compliance with internal procedures and quality assurance requirements; Serves on committees and completing special projects related to call center operations; Monitors work assignments for timeliness, accuracy, and other quality assurance requirements; Performs other duties as assigned. Serves as mentor and aids in training entry-level representatives on call center procedures Sends correspondence, reviews, updates and edits master record information. Monitors recorded and/or live calls to determine efficiencies and training needs of staff;

Evaluates workload distribution and provides supervisor with recommendations to balance accordingly; Responds to questions and resolves issues without involvement of a supervisor, unless necessary; Assists lower graded staff in providing customer service function to Veterans, Education, certification or licenses

DeVry of Long Beach Long beach, CA

Bachelor's degree

Major: COS

Completion date: 10/2001

Contact this candidate