Irene Vergara
San Marcos,CA
Summary
Results-driven and passionate professional with 10+ years of experience managing multiple revenue cycle management operations. Proven success determining improvement areas for documentation, workflow, and revenue cycle management process by utilizing effective problem-solving expertise. In-depth knowledge of federal, state, and all third-party insurance policies, practices, and procedures.
Overview
13
13
years of professional experience
Work History
Business Office Manager
Life Care Center of Vista DBA Vista View Post Acute
Vista, CA
02.2022 - Current
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Collaborated closely with clinical team to ensure proper documentation was obtained for accurate billing purposes.
- Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
- Continuously updated knowledge of industry regulations and compliance requirements, ensuring adherence to all applicable standards.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Maintained collections above 97% for all payers.
- Assessed current revenue cycle procedures and implemented improvements to foster efficiency
- Improved revenue cycle efficiency by streamlining processes and implementing best practices
Health Center Medical Billing Specialist
Casa de las Campanas
San Diego, CA
02.2018 - 09.2021
- Manage overall Health Center billing operations, such as HMO and Medicare
- Review treatment plans for changes in financial status by collaborating with Nursing Department Heads and Admissions
- Supervise revised contracts with proper billing rates
- Ensure fulfillment of benefits for all payers, including supplemental plans
- Organize and oversee multiple functions of PPS meeting
- Engage in monthly triple check process for Medicare part A, B, and Managed Care
- Drive accuracy of billing and reimbursement by conducting accounts audit
- Successfully mitigated outstanding aging for 120+ days
- Administered end-to-end aspects of software by serving as PCC (Point Click Care) Security User
- Gathered outstanding receivables by 97%
- Oversaw overall aspects of accounts receivables from posting, collection calls/letters, appealing denials/underpayments, and updating notes in PCC.
Business Office Manager
Encinitas Nursing & Rehab
Encinitas, CA
01.2015 - 01.2017
- Led various business activities, covering staff attendance, performance evaluations, and training of accounts receivable clerk, accounts payable, payroll, and receptionist
- Enabled all insurance information for admissions
- Recorded and secured collection efforts in Point Click Care
- Checked daily census with manual census
- Directed billing functions related to Medicare co-insurance to secondary payer, follow-up, resubmitting claims, and appeals for all managed care claims
- Modernized contract books for Admissions, Case Manager, and Business Office
- Verified accuracy of all demographics and payer trees; entered in PCC
- Achieved promotion from Assistant Business Office Manager to Business Office Manager by exceeding performance expectations
- Upgraded user access and verified PASRR's timely completion for all admissions by acting as administrator
- Minimized DSO from 100+ to 38 within first six months
- Decreased AR by processing process refunds and write-offs
- Reviewed level of care for skilled patients through organization of weekly meeting with facility Case Manager.
Revenue Cycle Manager
LifeHouse Vista Healthcare Center
Vista, CA
01.2011 - 01.2015
- Oversaw multiple activities, covering organization and prioritization of overall operations; managed competently and according to company's changing priorities and deadlines
- Joined various meetings, like daily manager, PPS, and weekly UR meetings
- Administered weekly/monthly billing for Medicare A and B, Medi-cal, Managed Care, Hospice, and Cal MediConnect plans as well as directed HealthNet, Care 1st, Molina, Community Health Group
- Supported Executive Director in reviewing income statement and monthly variance reports
- Drove billing accuracy by coordinating with several departments, such as MDS Nurse, Admissions Department, Rehab Department, Central Supply Department, Case Manager, and other departments
- Steered resident trust account deposits, posting, replenishing petty cash, and month end reconciliation
- Managed Medi-cal benefits twice a month to supervise share of cost increase/decrease, health plan changes, and loss/approval of benefits
- Gathered monthly share of cost payments and outstanding private balances
- Processed payroll under federal, state, and community guidelines
- Earned promotion from Assistant Business Office Manager to Revenue Cycle Manager by surpassing performance expectations
- Verified fulfillment of all policies and procedures applicable to business office operations and enabled compliance with department and organizational procedures
- Allocated benefit plan materials to staff members and described employee options, plan summaries, and assisted in enrollment process.
- Surpassed monthly collection goal from 107% to 115%
- Developed and maintained accurate records for daily census at 305 bed facility
- Streamlined end-to-end information through minimization of triple check meeting.
Education
Bachelor of Science - Behavioral Health
Grand Canyon University
Phoenix, AZ09.2025
Vocational - Medical Assistant
Concorde Career College
Garden Grove, CA06.2003
Vocational - Medical Administrative Assistant
Kaplan University
Vista, CA06.2000
Skills
- Operations Management
- Team Leadership & Direction
- Billing & Insurance Claims
- Reporting & Documentation
- Issues Resolution
- Strategic Planning & Execution
- Compliance Management
- Accounts Management
- Healthcare Industry Knowledge
- Claims Management
- Cash Flow Management
- Medical Billing
- Denial Resolution
- Problem-solving aptitude
- Financial analysis and reporting
- Proactive and Focused
Timeline
Business Office Manager
Life Care Center of Vista DBA Vista View Post Acute
02.2022 - Current
Health Center Medical Billing Specialist
Casa de las Campanas
02.2018 - 09.2021
Business Office Manager
Encinitas Nursing & Rehab
01.2015 - 01.2017
Revenue Cycle Manager
LifeHouse Vista Healthcare Center
01.2011 - 01.2015
Bachelor of Science - Behavioral Health
Grand Canyon University
Vocational - Medical Assistant
Concorde Career College
Vocational - Medical Administrative Assistant
Kaplan University
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