Data Entry for Transportation: Healthcare Billing Specialist
Resume:
LILIA RUIZ
CONTACT
PROFILE
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Detail oriented and highly organized Medical Biller with strong experience managing insurance claims, resolving unpaid and denied claims, and ensuring accurate reimbursement. Proven ability to work with provider portals, communicate effectively with insurance carriers and third parties, and maintain strict compliance with healthcare billing regulations. Known for persistence, accuracy, and follow through in fast paced medical environments.
SKILLS
EXPERIENCE
Credentialing, Customer Service, Data entry
Medical billing, electronic health records, Denial Management
Knowledge of Commercial Insurance eligibility Revenue Operations, Prior Authorizations for Medications and procedures, Knowledge of HIPPA Guidelines, Medical Billing & Claims Processing Insurance FollowUps & Denial Resolution CPT, ICD10, and HCPCS Coding Knowledge Provider & Payer Portal Navigation Patient Accounts & Account Reconciliation
Workers’ Compensation & ThirdParty Billing
HIPAA Compliance Professional Written & Verbal Communication
Attention to Detail & Time Management
Insurance eligibility verification and claims management using Availity, NaviNet, P2P, Claims Connect, Medicare portals, and Workers’ Compensation Board systems
Experienced with UHC and Emblem Health portals for claim submission, follow ups, and payment posting Allscripts, ECW, IClinic Trained in Epic.
Medical Biller- March 2023-Present
BIK Orthopedic-New York, NY
As a Biller for BIK Orthopedics my reasonability would be to Communicate with Insurance companies, Adjusters, Lawyers, and Patients. Review Remittance and EOB’s. Follow-up with denials and appeal letters. Create and Process Private Insurance/Workers’ Compensation prior authorizations for Orthopedic treatment via onboard portal. Knowledge of Workers’ Compensation Medical Treatment Guidelines and Forms. Knowledge of A/R reports and Healthcare payers such as Workers Comp, no-fault, PPO, HMO Medicaid, and Medicare.
CLEAR MD-New York, NY
Medical Biller August 2022-December 2023
Verify completeness and accuracy of all claims prior to submission with a goal of zero errors. Timely follow up on insurance claim denials, exceptions, or exclusions. Set up patient payment information in the EMR and ensure it is kept up to date Determine the appropriateness of pursuing legal remedies.
Answer questions from patients, clinical staff, and insurance companies. Regularly meet with supervisors to discuss and resolve reimbursement issues or billing obstacles. Manage all patient authorizations and/or restrictions. Regularly check patient eligibility, Post paid claims in EMR as necessary. Setup ERAs as necessary. Update job knowledge by participating in various educational opportunities, as requested by supervisor. Adhere to all HIPAA guidelines and regulations. Meet deadlines. Perform additional duties as requested by supervisor.
Planned Parenthood of Greater New York, NY
Revenue Billing Assistant February 2019 – 2020
Supported the Revenue Department by verifying insurance eligibility for all clients, including walk ins, using commercial insurance and Medicaid Managed Care plans for PPGNY and PPNC affiliates.
Assisted with payment posting and other assigned billing functions within the practice management system.
Prepared check requests and processed client or health plan refunds as directed.
Assisted with medical claim follow ups to help resolve outstanding balances.
Maintained organized revenue department files and scanned supporting documentation into the ECW system to ensure accurate recordkeeping
Aglow Dermatology – New York, NY
Medical Biller September 2013 – 2019
Prepared, reviewed, and submitted medical insurance claims to multiple insurance carriers using the iClinic EHR system, including CMS 1500 claim forms.
Responded to inquiries from patients, office staff, and insurance companies regarding billing questions, explanations of benefits (EOBs), and procedures.
I identified, researched, and resolved patient billing issues related to denied or unpaid claims.
Utilized monthly aging accounts receivable reports to track, follow up on, and resolve outstanding claims and unpaid statements. Monitored delinquent accounts and reported claim status while performing collection activities, including patient outreach, claim corrections, resubmissions, and initiating collection agency referrals when necessary.
Posted and processed payments received from patients and insurance carriers accurately and timely.
Maintained strict confidentiality and ensured full compliance with HIPAA regulations and privacy standards.
EDUCATION
Lowell High School High School Diploma
Career Academy Medical Assistant, Medical Billing Certificate
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