Adelina Ortega
Tucson,AZ
Summary
Accomplished Medical Biller/Office Assistant at Medstar Physical Therapy Inc., adept in insurance claims and patient billing, enhanced collections by streamlining claims processes. Demonstrated exceptional customer service and teamwork, successfully resolving denied claims and improving reimbursement rates. Expert in HIPAA compliance and medical terminology, significantly contributing to operational efficiency and customer satisfaction.
Professional with strong expertise in medical billing, bringing reliable and adaptable approach to navigating evolving needs. Proven track record in team collaboration and achieving results through effective communication and problem-solving. Skilled in coding, claims processing, and patient account management, with keen eye for accuracy and compliance. Known for dependability and focus on efficiency, ready to contribute to streamlined billing operations.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level position. Ready to help team achieve company goals.
Dedicated administrative professional with successful experience in fast-paced office settings. Hardworking team player with expertise in completing various clerical tasks and offering staff support. Responsible, punctual and productive professional when working with little to no supervision.
Overview
31
31
years of professional experience
Work History
Medical Biller/Office Assistant
Medstar Physical Therapy Inc.
09.1999 - Current
- 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.
- Posted payments and collections on regular basis.
- Collected payments and applied to patient accounts.
Associate Tech Claims Specialist
Coventry Health Care
02.2006 - 06.2007
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Conducted regular audits of claim files, ensuring compliance with internal and external regulations and standards.
- Negotiated settlements with claimants and attorneys, achieving favorable outcomes for all parties involved.
Medical Historian/Medical Assistant
M.J. Medical Management
05.2001 - 02.2006
- Maintained strict confidentiality of sensitive patient information, adhering to HIPAA guidelines and protecting privacy rights.
- Conducted regular audits of medical history records, ensuring accuracy and completeness as well as identifying any potential discrepancies or inconsistencies.
- Managed a database containing thousands of individual patient records, ensuring timely updates and secure storage.
- Reviewed existing processes for collecting and storing medical histories, implementing improvements as needed to maximize efficiency and maintain high-quality records.
- Trained new team members on effective interview techniques, documentation practices, and database management skills integral to the Medical Historian role.
Fine Jewelry Assistant Merchandiser
J.C.Penney
10.1993 - 05.1999
- Established strong working partnerships with key stakeholders such as marketing teams or suppliers, demonstrating a collaborative attitude that enabled successful execution of various projects.
- Developed strong relationships with store managers to gather feedback on merchandise mix and address specific needs or concerns promptly.
- Increased sales by effectively analyzing market trends and implementing strategic merchandising plans.
- Supported data-driven decision-making processes by conducting thorough sales analysis and generating insightful reports.
- Improved visual displays with creative arrangements, enhancing overall store presentation and driving customer engagement.
- Streamlined order processing procedures, ensuring timely delivery of merchandise to stores nationwide.
- Enhanced team productivity through effective scheduling, task distribution, and performance monitoring.
Education
Certification - Medical Billing
Baldwin Park Vocational Adult School
Baldwin Park, Ca.09-1999
High School Diploma -
Gladstone High School
Covina, Ca.06-1995
Skills
- Insurance claims
- Medical billing
- Insurance billing
- Electronic claims
- Patient billing
- Billing and collection procedures
- Customer service
- CPT knowledge
- Accounts receivable
- Claim submission
- Data entry
- Insurance claims processing
- CMS-1500 billing forms
- Payment posting
- Claims processing
- Payment collection
- Account updating
- Collections processing
- Paperwork and documentation
- Payment processing
- Claim review
- Billing codes
- Account follow-up
- Information inputting
- Insurance collections
- Submission of medical claims
- Balance reconciliation
- Verbal and written communication
- Records maintenance
- ICD-9
- Medical terminology
- ICD-10 coding
- Payer contracts
- 45 WPM
- Patient collections
- Collection calls
- Work prioritization
- Knowledgeable in Microsoft Word, Microsoft Office Excel
- Teamwork and collaboration
- Collections management
- Critical thinking
- Medical claims submission
- Multitasking and organization
- Patient account analysis
- Claims review
- ICD-10
- Electronic health record software
- HIPAA compliance
Languages
Spanish
Native or Bilingual
Timeline
Associate Tech Claims Specialist
Coventry Health Care
02.2006 - 06.2007
Medical Historian/Medical Assistant
M.J. Medical Management
05.2001 - 02.2006
Medical Biller/Office Assistant
Medstar Physical Therapy Inc.
09.1999 - Current
Fine Jewelry Assistant Merchandiser
J.C.Penney
10.1993 - 05.1999
Certification - Medical Billing
Baldwin Park Vocational Adult School
High School Diploma -
Gladstone High School
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