Abril Caro
Los Angeles,CA
Summary
10+ Years of Revenue Cycle Management Experience. A detailed-oriented, highly focused medical claim and billing specialist with the big picture vision, leadership skills, and tenacity to successfully manage daily operations and complicated assignments. Extensive knowledge of multiple billing software, coding practices, and medical terminology. Uses logic and reason to identify the strengths and weaknesses of alternative solutions, conclusions, and approaches to work-related issues. Always leads by example and is able to: coach, give feedback, build morale, present initiatives, and offer recommendations/solution. Takes pride in clean claims submission and low DSOs.
Overview
15
15
years of professional experience
Work History
Revenue Cycle Manager
Curative Inc.
11.2020 - 06.2021
- Creating Billing Processes
- Collaborated with IT Department to create Insurance Billing Portal
- Transitioned off-site billing team to in-house
- Transitioned outsourced billing process to in-house using Quadax as Clearing House
- Created Credit, Refund and Payor Reject Processes
- Set up Billing Department Call Center
- Created Paid to Patient process
- Liaison for billing company Quadax
- Monitored and guided revenue cycle operations
- Assessed current revenue cycle procedures and implemented improvements to foster efficiency
- Supported clinical team members with revenue cycle procedures and addressed issues
- Performed routine closings, maintained clean, accurate and accessible records and kept close eye on transaction updates throughout each quarter
- Established and enforced internal controls, workflows and policies for tracking, reconciling and reporting on accounting activities
- Recruited, interviewed, hired and trained 11 employees
- Developed strategic plans for day-to-day operations
- Identified improvement changes regarding key processes for internal controls and accounting procedures
- Supported Chief Financial Officer and Director with special projects and additional job duties
- Established and checked coding procedures, monitored reports and updated internal files
Billing Manager
Fulgent Genetics
02.2018 - 12.2018
- Established and managed the Medical Billing and Collections Department that consisted of Medical Billers, Collectors, Administrative Assistant and Cash Poster
- Implemented new procedures to help with prior authorization process due to being needed for most out of network services
- Implemented workflow for Payer Reject Projects
- Created SOP's and guidelines for specific insurance payors such as Medicare and Medicaid
- Created scripts to help with different customer service scenarios
- Handled all patient and client escalated phone calls.
- Reviewed billing problems, researched issues and resolved concerns.
- Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
- Worked with customers to develop payment plans and bring accounts current.
- Trained and mentored staff on procedures, compliance requirements and collections techniques.
Billing Manager
Case Anywhere
01.2016 - 02.2018
- Supervised and untangled any situations that arose in the billing process
- Evaluated and maintained a 750+ client database, cycling through every 45 days
- Developed and implemented spreadsheet system to track billables across multiple departments, reducing errors by 95%
- Assisted various departments with payment reconciliations and collected outstanding balances
- Orchestrated collections of numerous open invoices backlogged from 2012
- Created monthly reports for submission to senior management, analyzing all receivables to ensure accurate receipt of payments
- Kept senior management informed of account status, errors, rejections on a weekly and ad-hoc basis
- Fostered positive relationships with clients through email and phone which increased client retention.
Billing Supervisor
Genoptix Medical Laboratory
08.2008 - 07.2013
- Oversaw 15 billing coordinators and provided guidance in handling difficult or complex problems or in resolving escalated complaints or disputes
- Reviewed performance evaluations on each coordinator and initiated any personnel actions as required
- Achieved goal of 90% of all billings within 10 days sales outstanding (DSO)
- Consistently offered recommendations to management concerning procedural changes
- Designed and implemented custom build coding software, which reduced operating costs by $30,000/year
- Standardized resolution processes for the customer service department resulting in faster turn-around-times
- Also, developed coding sheets to help both Billing and IT Departments create proper billing measures for new solid tumor specimen testing, set by Medicare.
Lead Accounts Receivable Specialist
Genoptix Laboratory
01.2007 - 08.2008
- Managed the receipt and recognition of 75% of the company's revenue stream by handling the majority of government payor activities
- Expanded the team to include a new collector which aided in the overall clean- up of Government payors
- Motivated and cultivated an efficient AR/ Collections team to uphold certain quality and productivity standards assigned
- Worked closely with senior management to implement a new internal process to reduce the number of Medicare appeals on local coverage determinations (LCDs) and other unpaid charges
- Designated as one of a handful of AR specialists to support VP of Sales and sales team in resolving issues with, and the collection of, past receipts
- Served as the liaison to Quadax— the clearing house and billing provider—maintaining direct communication with their upper level management team to identify and mitigate any system issues.
Senior Medical Billing Representative
Genoptix Medical Laboratory
08.2006 - 01.2007
- Appointed by senior management to handle complex billing issues for high priority projects
- Successfully coded 450 claims in a single day following a backlog due to absentees
- Trained new and existing team members on reports, Genoptix's standard operating procedures (SOPs), and carrier information; as well as tracked each person's daily production and quality control (QC) issues
- Compiled and prepared special reports for distribution to senior management and billing coordinators
- Analyzed and researched denials, followed up with the payor to verify timely receipt of appeals, checked status of review, submitted required documentation, and tracked overall appeal process
- Closely monitored outstanding balances and made appropriate actions, in the best interest of Genoptix, to ensure clients paid as billed.
Medical Billing Representative
Genoptix Medical Laboratory
03.2006 - 08.2006
- Worked in tandem with senior management and five (5) billing coordinators to set, define, and meet daily performance and production goals
- Ensured proper codes were listed in each claim; corrected or reclassified coding in Excel, if necessary, which resulted in the collection of $2M in August 2006
- Also, identified and resolved discrepancies and claims delay issues that impact billing and collections
- Prepared daily status reports of delinquent accounts to Genoptix billing department, resulting in lower DSOs
- Evaluated the patients financial status and established budget payment plans.
Education
Certification - Business Management/ Administrative Assistant
Bryman College
City Of Industry, CA06.2005
Skills
- Past Due Account Management
- Conflict Resolution Tactics
- Revenue Cycle Management
- Customer Accounts Management
- Payer Reject Resolution/ Claim Resubmission
- Electronic Document Management System
- Customer Communication
- Account Resolutions
- Compliance Requirements
- Quality Improvement Plans
- Spreadsheet Tracking
- Build Customer Relationships
Languages
Spanish
Native or Bilingual
Timeline
Revenue Cycle Manager
Curative Inc.
11.2020 - 06.2021
Billing Manager
Fulgent Genetics
02.2018 - 12.2018
Billing Manager
Case Anywhere
01.2016 - 02.2018
Billing Supervisor
Genoptix Medical Laboratory
08.2008 - 07.2013
Lead Accounts Receivable Specialist
Genoptix Laboratory
01.2007 - 08.2008
Senior Medical Billing Representative
Genoptix Medical Laboratory
08.2006 - 01.2007
Medical Billing Representative
Genoptix Medical Laboratory
03.2006 - 08.2006
Certification - Business Management/ Administrative Assistant
Bryman College
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