Medical Billing & AR Specialist expert with 16+ years

Maria V. Garcia

Santa Ana, California ***** • 714-***-**** • *************@*****.***

Professional Summary

Medical Biller/AR Specialist with 16+ years of extensive experience in patient billing and insurance claims management. Successfully resolved denied claims through effective communication, driving successful reimbursements. Demonstrated expertise in verifying insurance eligibility and processing payments accurately, enhancing account recovery rates. Passionate about fostering teamwork and providing exceptional patient customer service to tackle complex billing challenges.

Experience

10/2008 – 03/2025

Billing Specialist/ Account Receivable Ventra Health Corporation Santa Ana, CA

●Worked closely with health insurance payors and patients to resolve patient billing issues and physician anesthesia related-claims, fostering strong relationships, and ensuring timely payment.

●Communicated with insurance payers to resolve denied claims and resubmitted corrected claims or filed appeals.

●Managed account billing and follow-up on overdue payments from insurance companies and patients balances.

●Verified insurance of patients to determine eligibility coverage.

●Managed appeals/reconsiderations process for denied claims, resulting in successful reimbursement from insurance companies.

● Maintained and updated patient medical records and billing documentation in EMR systems while ensuring HIPAA compliance.

●Handle patient charts, enter patient demos, charge tickets to billing system.

●Requested retro authorization to insurances for denied services.

●Review, analyzed, and interpreted EOB's and remittance advice to ensure accurate reimbursement from insurance carriers.

●Trained new hires and staff in medical billing software, guidelines and system process.

●Review outstanding balances owed by patients. Billed patients for outstanding balances after insurance payments. Made collection calls to patients on outstanding balances. Initiated collection actions if necessary resulting in improved account recovery efforts.

●Provided customer service to patients/customers via phone calls and email regarding claims and statements billing-related inquiries, answer questions and concerns on a daily basis. Collaborated with patients to resolve account issues and outstanding balances.

●Processed patients payments via telephone and in person with focus on accuracy and efficiency.

●Demonstrated proficiency in paper and electronic billing processing. Printed paper claims and mail out to insurances.

●Handle EDI eligibility/claim rejections, made necessary corrections and updated missing information.

Skills and Knowledge

• Data Entry • Account Receivable • Anesthesia Professional Billing • Insurance Claims filing • Customer Service • Patient Account Representative • Team player • Payment Processing • CPT & ICD-10 Coding • MedSuite • EMR system • Epic Care • Cerner • Citrix • Medical Records management • CMS-1500 billing forms • Claim Disputes/Appeals • PDR form • Denial management• Eligibility insurance verification • Authorizations • EOB's review • Collections Calls • Trained new hires & Colleagues • HIPPA compliance • Multi-tasking and organization • Verbal & written communication • Basic computer • Microsoft Word • Outlook • Teams • Excel • Payer contracts

Payers: Medicare • Medicaid (Medi-cal) • CCS • CalOptima • Workers Compensation • TriCare •Triwest • VA • PPO/HMO/IPA/EPO/POS • Prospect • Optum • Alta Med • Scan • Kaiser• Blue Cross/Blue Shield, UHC, Health Net, Cigna, Aetna • Commercial non contracted and private insurance.

Education

06/2008

Newbridge College Medical Billing and Coding Certificate Santa Ana, CA

06/2006

Santa Ana High School High School Diploma Santa Ana, CA

Languages

Bilingual English and Spanish

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