Insurance Medical
Resume:
Hilda M. Tirado
Schiller Park IL 60176
EDUCATION
**/**-**/** ***** Eastern IL University, Chicago, IL
**/**-*/** **** SCHURZ High School, Chicago, IL
EXPERIENCE
12/05-4/12- LOYOLA UNIVERSITY MEDICAL CENTER, Westchester, IL
Lead of collections
Responsible for overseeing daily functions such as training, educating, assisting and motivating staff members. Create and implement policies and procedures for the collections department. Educate and train staff on the processes, policies and guidelines of the collections department. Monitor their work on a daily basis and provide feedback for any improvements. Create reference guides for the staff to utilize in order to insure that the quality and quantity of work is maintained. Identify issues when working all payers and being able to find resolution. Responsible for meeting and maintaining deadlines on a daily basis. Meet with management on a bi-weekly basis in order to identify, communicate and provide updates as issues arise. Request and analyze reports pertaining to all payers as needed. Contacted various payers such as Workers comp, Medicare, managed care and BCBS for status of claim/denial of claim and appeal of claim. Rebilled claim when necessary. Very knowledgeable in the IL laws of Workers comp, Managed Care, Medicare, Medicaid. Familiar with CPT and ICD-9 coding. Responsible for maintaining a high level of professionalism and communication. Strong written and oral skills
10/01-12/05 HEALTHCARE INFORMATION SERVICES, DesPlaines, IL
Client Services Coordinator
Review of Orthopedic physicians aging reports and following up on outstanding managed care and worker’s comp claims in order to provide means of resolution. Updating and correcting information on patient accounts, data entry, appealing denied surgeries and/or office visits, contacting insurance companies on outstanding claims, contacting attorneys in reference to work comp litigation cases and contacting the patient on settled work comp claims. Contacting and scheduling quarterly meetings with the physicians to discuss their account receivables.
Preparing packets such as creating charts and/or graphs to show any significant increase in payor mix and/or decrease of charges and payments. Develop a rapport with each physician and maintaining professionalism at all times. Discussing issues with the physician that he or she may have concerns with billing. Providing information or ideas to bring resolution to the issues at hand. Meeting with management team to discuss issues and correct the problems to prevent issues from reoccurring. Working on special projects as requested by the physicians or Vice President of Operations to ensure prompt resolution of any given problem or concern
8/99-10/01 EVANSTON NORTHWESTERN HEALTHCARE, Evanston, IL
Billing Systems Specialist
Handle billing and system questions, issues, special projects (closing out off site system data base). Provide daily audits of claims and inventory for accuracy prior to billing insurance. Handling claims for worker’s comp, Medicare, Medicaid, and all commercial insurances. Reprocessing rejected claims, maintaining logs and report coding errors, assist the supervisor with the daily activities of the day. Familiar with ICD-9 and CPT coding
12/97-08/99 NORTHSUBURBAN CLINIC, Skokie IL
(Providing services for ENH Medical)
Accounts Specialist
Ensuring the accuracy and integrity of patient’s accounts, calling various insurance medical institutes for claim status, processing claims to insurance companies, review all eob’s and apply
them to the patient’s account, set up and update patient’s file in the system, answer high volume of incoming calls regarding inquires on accounts, sending out statements and collection letters to outstanding accounts and posting payments into accounts
SYSTEM USED: IDX, EPIC, PPM, SDM, MEDIPAC, MEDIC VISION, Ecommerce, NDAS, Paper vision, Excel and Word Perfect
MILITARY EXPERIENCE:
10/96-10/04- U.S. Army Reserves, 853rd Transportation Hobart, IN
References available upon request
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