RAQUEL DE LA ROSA
Los Angeles,CA
Summary
Analytical and self-motivated Medical Billing Specialist with 10+ years of experience in assigning accurate medical codes, utilizing billing software, and processing claims accurately. Highly skilled in verifying insurance details, analyzing financial reports, and adhering to healthcare regulations and compliance requirements.
Overview
17
17
years of professional experience
Work History
Revenue Project Manager
All For Kids (Children's Bureau Of Southern Ca)
11.2023 - Current
- Manage financial operations including billing, collections, insurance verification, and payment processing to maintain a steady cash flow for the practice.
- Provide exceptional customer service to patients, addressing concerns and answering inquiries related to billing and insurance coverage.
- Conduct bi-weekly audits to capture any pending claims that require follow up.
- Played a key role in improving the organization''s overall financial performance, minimizing lost revenue due to denied claims.
- Facilitated cross-functional meetings with clinical staff, addressing documentation-related issues that contributed to claim denials.
- Identified patterns in payer denials, implementing corrective actions to prevent future occurrences.
- Expedited claims resolution by effectively collaborating with providers, payers and clients to obtain necessary documentation or missing information.
Revenue Manager
Children's Bureau of Southern California
07.2018 - 10.2023
- Identified issues regarding delayed or incomplete payments and followed through to resolution.
- Reduced discrepancies in billing reports with thorough review processes and diligent follow-ups on outstanding accounts.
- Minimized errors in customer billing information through diligent verification practices and prompt issue resolution.
- Facilitated monthly meetings with team members to discuss performance metrics, share best practices, and address any concerns or challenges faced during the billing cycle.
- Collaborated closely with other departments, fostering strong working relationships to expedite resolutions of cross-functional issues impacting revenue collection.
- Worked side to side with the intake department for private insurance new clients.
- Answered phone calls and provided new clients with required paperwork to initiate service.
Business Office Manager-Payroll
Genesis Healthcare (Sun Healthcare)
02.2013 - 06.2018
- Verified and submitted timekeeping information for accurate and efficient payroll processing (50+clients).
- Performed calculations in overtime, vacation, and sick hours to provide accurate data to payroll processing database.
- Reduced payroll errors by diligently auditing employee timecards and promptly addressing discrepancies.
- Managed a high volume of vendor invoices, prioritizing payment schedules to optimize cash flow and maintain strong vendor relations.
- Prevented potential fraud or errors by meticulously reviewing incoming invoices for accuracy before entering into accounting system.
- Ran weekly reports to minimize claim denials, outstanding notes and claims with problems. Responsible for tracking other health insurance claims and payments.
Medical Biller
Sun Healthcare
10.2007 - 03.2013
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Filed and updated patient information and medical records.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Collected payments and applied to patient accounts.
- Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Liaised between patients, insurance companies, and billing office.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Education
Billing And Coding -
Everest College
Gardena, CA09.2008
Skills
- Claims Processing
- Payment posting
- Collections
- Research and due diligence
- Customer service support
- Private Insurance Billing
- Problem-solving abilities
- Critical Thinking
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Revenue Project Manager
All For Kids (Children's Bureau Of Southern Ca)
11.2023 - Current
Revenue Manager
Children's Bureau of Southern California
07.2018 - 10.2023
Business Office Manager-Payroll
Genesis Healthcare (Sun Healthcare)
02.2013 - 06.2018
Medical Biller
Sun Healthcare
10.2007 - 03.2013
Billing And Coding -
Everest College
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