Adrian Parra
Summary
A detail-oriented and analytical Billing and Collections Specialist with 5+ years of experience handling billing processes, analyzing financial data, and managing collections. Skilled in identifying revenue opportunities and resolving payment discrepancies.
Overview
15
15
years of professional experience
Work History
RCM SENIOR COLLECTION REPRESENTATIVE
Evernorth Health Services | Accredo
02.2022 - Current
- Manage the daily BCBS AL future ship report, coordinating across departments to minimize Accredo's bad debt risk and streamline payment processes
- Address escalations by providing expert responses to queries from various company teams, contributing to cohesive inter-departmental communication
- Verify the accuracy of CPA billings, promptly identify and rectify discrepancies, and communicate corrective measures to relevant parties
- Ensure effective coordination with BCBS AL to acquire approved accept assignment requests (AOBs) for accounts and verify the submission of claims with accurate billing codes to facilitate proper billing processes and direct payment from BCBS AL
- Play a pivotal role in reducing bad debt by effectively coordinating claim issue resolutions, which prevent patient balance escalations
- Conduct thorough investigations into missing payments, supplying critical data to aid the Cash Department in maintaining financial integrity.
BILLING SPECIALIST
St. Mary's Healthcare System for Children
08.2014 - 05.2019
- Conducted comprehensive A/R analysis of over 700 patient accounts, identifying discrepancies and evaluating outstanding balances to maintain account integrity; successfully reduced Medicaid receivables by $300,000 for patients over 18 years old and by $200,000 for those under 18
- Following the introduction of Meditech software in March 2015, meticulously reviewed unbilled services against clinician session notes to correct time discrepancies, uncovering over 50 billing inconsistencies monthly
- Managed monthly New York State Medicaid billing for the Care At Home program using the MIT billing system, generating revenue in excess of $60,000
- Handled weekly New York State Medicaid billing for the Home Care program through the Allscripts system, producing over $380,000 in revenue
- Oversaw bi-weekly commercial billing for the Home Care program, coordinating with commercial collectors to address rejected claims and assist in resolving unpaid claims, generating $200,000 in revenue; submitted manual claims using UB04 forms for insurances lacking electronic claim capabilities
- Supported Medicaid CSP balance billing through E-Paces, assisting with the investigation and correction of billing discrepancies to ensure timely claim resubmission within Medicaid deadlines.
FULL TIME BILLER
St. Mary's Healthcare System for Children
02.2012 - 08.2014
- Managed weekly and monthly New York State Medicaid billing for Home Care and Care At Home programs, generating significant revenue ($380,000 and $60,000 respectively) using the Allscripts and MIT billing systems
- Collaborated with patient service coordinators and nursing management in the Rehab and Homecare Departments to resolve over 35+ weekly billing discrepancies, enhancing processing efficiency and ensuring compliance with insurance billing deadlines
- Developed and maintained detailed spreadsheets to track and monitor corrections, ensuring compliance in billing processes and documentation standards across various departments
- Conducted detailed weekly audits of over 250 pages of Medicaid remittances and 300+ per-diem nursing visits, identifying and resolving payment denials and discrepancies to prevent incorrect documentation processing
- Regularly validated therapy and nursing session notes in Allscripts for accurate billing based on patient eligibility, and manually posted takeback transactions to ensure precise financial records
- Initiated comprehensive patient account reviews to recover over $100,000 in past accounts receivable balances and increased billing return rates by 20% through meticulous review and prompt correction of billing errors.
RECEPTIONIST/BILLER
St. Mary's Healthcare System for Children
02.2010 - 06.2012
- Recruited as a permanent receptionist for the Finance Department, effectively managing visitor reception and directing numerous telephone inquiries to appropriate personnel
- Ensured accurate implementation of the new billing system, Allscripts, by processing and validating initial session notes
- Demonstrated meticulous attention to detail by thoroughly reviewing therapy session notes to confirm data accuracy and compliance for final billing processes
- Led two significant projects within the Finance Department: facilitated the upgrade of therapist laptops to new clinical software and conducted thorough reviews of clinician notes to ensure adherence to doctors' orders
- Coordinated corrective actions by securing clinician cooperation to amend any non-compliant documentation.
TEMP BILLER
St. Mary's Healthcare System for Children
08.2009 - 02.2010
- Successfully processed over 750 therapy session notes weekly using the Cerner database
- Ensured prompt and accurate payments for therapists and proper billing to New York State Medicaid and commercial insurance
- Utilized MIT, an in-house proprietary billing and payroll program, integrated seamlessly with Cerner to streamline billing processes.
Education
Master of Science - Accounting With A Concentration in Taxation
Southern New Hampshire University
Manchester, NH05.2024
Bachelor of Science in Accounting -
CUNY York College
Jamaica, NY05.2014
Skills
- Microsoft Office
- Account Reconciliation
- Collections
- Analytical and problem-solving
- Attention to detail
- Collaboration
- Time management
- Troubleshooting and research
- Goal-Oriented
Languages
Spanish
Native or Bilingual
Timeline
RCM SENIOR COLLECTION REPRESENTATIVE
Evernorth Health Services | Accredo
02.2022 - Current
BILLING SPECIALIST
St. Mary's Healthcare System for Children
08.2014 - 05.2019
FULL TIME BILLER
St. Mary's Healthcare System for Children
02.2012 - 08.2014
RECEPTIONIST/BILLER
St. Mary's Healthcare System for Children
02.2010 - 06.2012
TEMP BILLER
St. Mary's Healthcare System for Children
08.2009 - 02.2010
Master of Science - Accounting With A Concentration in Taxation
Southern New Hampshire University
Bachelor of Science in Accounting -
CUNY York College
Similar Profiles
Diana FlorioDiana Florio
Vice President, Physician Engagement and 340B at Accredo an Evernorth CompanyVice President, Physician Engagement and 340B at Accredo an Evernorth Company
Ariel MaslowAriel Maslow
Case Management Lead Representative at Evernorth Health ServicesCase Management Lead Representative at Evernorth Health Services
Laxmi Sujata VemuriLaxmi Sujata Vemuri
Senior Executive Assistant at Evernorth Health ServicesSenior Executive Assistant at Evernorth Health Services