Patient Care Coordinator with HIPAA & Billing Experience

Summary

To seek and maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Experience

UnitedHealthcare Austin, TX

Patient Care Coordinator 07/2021 - 10/2025

· Established rapport and relationships with patients and external partners to cross-train and support medical staff. · Reviewed each step of patient care and made proactive adjustments to avert issues. · Worked closely with patients to deliver excellent and direct individualized patient care. · Encouraged patients to schedule recommended tests and procedures. · Explained upcoming treatment preparation, instructions and other facts to patients. · Worked with patients to schedule tests and procedures. · Data entry, filing, tracking time frames and status. Baylor Scott White Hospital Lakeway, TX

Access Service Representative II 12/2018 - 07/2021

· Determined patient financial needs and referred eligible patients to proper county, state or federal agencies to obtain financial assistance. · Collected and entered patient demographic and insurance data into computer database to establish patient's medical record. · Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy. · Explained estimated cost for medical treatments and answered patient questions to promote good understanding of proposed services. · Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations. · Identified insurance payment sources and listed payers in proper sequence to establish chain of payment. · Obtained patient's insurance information and determined eligibility for benefits for specific services rendered. · Facilitated communication between patients and various departments and staff. · Offered simple, clear explanations to help clients and families understand hospital policies and procedures. Baptist Health Systems San Antonio, TX

Charge Processor/Trauma Registrar 11/2014 - 05/2018 Provided support with nurse auditors and charge coordinators to interpret, identify errors, investigate charges for accuracy of ER charges. · Identified discrepancies and located additional revenue opportunities. · Organized assignments for staff, performed audit reviews, prepared summary reports to management and Texas Dept of Health Services, transcribed physician orders, maintained patient charts and supported internal initiatives as needed. · Produced reports from data source to ensure proper coding for injury severity. · Utilized audits and controls to accurately manage cash. · Secured confidential patient information from unauthorized access. · Performed regular quality and validation assessments on patient data to verify accuracy. · Exceeded department-specific productivity standards, collection targets, quality audit scores for accuracy productivity and collection standards for registrations and insurance verifications. · Facilitated scheduling in identified areas for ancillary testing. · Studied and researched various medical terms as well as software and coding systems · Used (Cerner) to code and categorize health information for analysis and insurance reimbursement purposes. · Conducted quality improvement and customer satisfaction surveys to evaluate patient care · Conducted research, gathered information from multiple sources and presented results · Collected, organized and entered patient data into medical systems · Retrieved medical data for physicians and patients.

Christus Santa Rosa Westover Hills Hospital San Antonio, TX Administrative Assistant 08/2012 - 11/2014

· Administrative and clerical support, prioritized workload, transcribed services, and data entry, management of supply levels to include crash carts, processed all ”stat” and “now” orders, identified shortage in staff, intercom services, greeted patients and logged entry, PBX/phone services, arranged patient charts for transport, coordination of bed placement and paperwork, regularly tested equipment for incoming/active patients and adhered to all departmental and organizational rules and regulations. · Restocked supplies and placed purchase orders to maintain adequate stock levels. · Managed Access databases converting complex data into easy-to-interpret data. · Arranged rapid office equipment repair and maintenance with vendors. · Executed record filing system to improve document organization and management. · Supported logistics for programs, meetings and events, including room reservations, agenda preparation and calendar maintenance. · Organized weekly staff meetings and logged minutes for corporate records. · Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data. · Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors. · Sorted and distributed office mail and recorded incoming shipments for corporate records. · Scheduled office meetings and client appointments for staff teams. · Interacted with vendors, contractors and Alma Lombera

512-***-**** ****.*******@*****.*** Austin, TX professional services personnel to receive orders, direct activities and communicate instructions. · Performed research to collect and record industry data.

Perinatal And Fertility Specialists Of San Antonio San Antonio, TX Medical Billing Specialist 05/2009 - 06/2012

· Electronically and manually filed claims using claims processing system for post insurance charges, assisted in disputes, complaints, appeals, denials and billing discrepancies. · Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable. · Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy. · Reviewed patient records, identified medical codes and created invoices for billing purposes. · Communicated with insurance providers to resolve denied claims and resubmitted. · Prepared billing statements for patients and verified correct diagnostic coding. · Trained new employees on multiple medical billing programs and data entry software. · Managed collections claim for unpaid bills against estates of debtors. · Posted and adjusted payments from insurance companies. · Identified and resolved patient billing and payment issues. · Located errors and promptly refiled rejected claims. · Evaluated patients' financial status and established appropriate payment plans. · Precisely completed appropriate claims paperwork, documentation and system entry. · Determined prior authorizations for medication and outpatient procedures. · Precisely evaluated and verified benefits and eligibility. · Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts. · Printed and reviewed monthly patient aging report and solicited overdue payments. · Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections. · Filed and updated patient information and medical records. · Collected payments and applied to patient accounts. · Set up and maintained new electronic billing system. · Posted payments and collections on regular basis. · Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable. · Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers. · Managed billing calendar and scheduled claims for payments. Nevada Eye Care Professionals Las Vegas, NV

Medical Billing Specialist 03/2006 - 11/2009

· Processed and investigated claims, reported, filed and maintained sensitive materials and light bookkeeping. · Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable. · Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy. · Reviewed patient records, identified medical codes and created invoices for billing purposes. · Communicated with insurance providers to resolve denied claims and resubmitted. · Prepared billing statements for patients and verified correct diagnostic coding. · Trained new employees on multiple medical billing programs and data entry software. · Posted and adjusted payments from insurance companies. · Identified and resolved patient billing and payment issues. · Located errors and promptly refiled rejected claims. · Evaluated patients' financial status and established appropriate payment plans. · Communicated effectively and extensively with other departments to resolve claims issues. · Maintained and updated collections tracking spreadsheet to help organize payment information. · Precisely completed appropriate claims paperwork, documentation and system entry. · Determined prior authorizations for medication and outpatient procedures. · Precisely evaluated and verified benefits and eligibility. · Prepared billing correspondence and maintained database to organize billing information. · Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts. · Printed and reviewed monthly patient aging report and solicited overdue payments. · Gathered information from multiple sources to simplify billing and organize accounts. · Posted surgical charges for all practice providers. · Delivered timely and accurate charge submissions. · Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections. · Filed and updated patient information and medical records. · Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies. · Collected payments and applied to patient accounts. · Set up and maintained new electronic billing system. · Prepared accounts with past due balances and transferred those cases to collection agency. · Posted payments and collections on regular basis. · Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable. · Reviewed patient diagnosis codes to verify accuracy and completeness. · Managed billing calendar and scheduled claims for payments. · Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers. Skills

Medical terminology, Statistical Data Management, Paging Systems, Formularies, Insurance Verification, Information Collection, Fee Collection, Patient Relations, Scheduling, Teamwork, HIPAA Compliance, Insurance Knowledge Education

Serra High School San Diego

High School Diploma 06/1996

Certificates

ICD-10 Certification

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