ALBERTA REYES
EDINBURG
Summary
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
29
29
years of professional experience
Work History
Contract Manager
Doctors Hospital at Renaissance
07.2019 - Current
- Manage hospital payer contract negotiations to maximize hospital reimbursements as allowable for all hospital service lines
- Negotiate Out of Network Single Case agreements to secure maximum reimbursement
- Negotiate Kidney Transplant Single Case Agreements to obtain the maximum allowable reimbursement, inclusive to cover TOSA Organ Acquisition costs
- Manage FinThrive Contract Manager System to trend and track underpayments for appeal recoveries
- Review and pre-approved billing edits prior leadership approval to maximize charge capture and increase reimbursements as allowable by payers rules and guidelines
- Manage Price Transparency updates
- Assist in yearly Charge Master increases
- Provide reimbursement calculation training to Business Office staff as well as payer rules and guidelines on billing, collections and appeals
- Manage hospital credentialing inclusive of provider based locations
- Provide reimbursement calculation training as needed
- Other duties as assigned
Revenue Cycle Educator
Doctors Hospital at Renaissance
06.2016 - 06.2019
- Created revenue cycle curriculums based on billing, collections, fee schedules, reimbursements, appeals and more
- Educated all new and tenured employees on Patient Accounting Revenue Cycle functions.
- Assisted in educating Pre-Access departments in Patient registration, creation of medical records and visit id’s for each visit, cash posting, and insurance verification and authorizations techniques.
- Assisted in educating RMF Professional Billing & Collections team in professional billing, collections, appeals and cash posting techniques.
- Creation of department Standard Operating Procedures and workflow processes.
Billing & Collections Manager-Business Office
Doctors Hospital at Renaissance
02.2013 - 06.2016
- Experience in Management Leadership, overseeing 80 employees + (Billers, Collectors, Appeals)
- Performed monthly QA reviews on employees
- Reviewed Denial trending and reporting on a weekly basis
- Educated internal and external departments on root cause and provided plan of action to avoid loss of revenue and/or prevent future denials
- Prepared and Organized weekly staff meetings to provide education on payer updates, and reviewed revenue loss and recovery expectations & tactics
- Assisted in setting up Relay Assurance Billing System by creating billing edits/bridges according to payer rules and guidelines for effective billing, charge capture
- Assisted in setting up AEOS Tool Management for A/R driver worklists per financial classifications for reach Business Office teams
- Managed the Billers and oversaw the daily billing, transmission, rejection and edit error reports to ensure effective and accurate billing was performed according to payer rule and guidelines.
- Managed the Collectors to ensure appropriate collection techniques were being utilized per payer contract for maximized and consistent cash flow
- Managed the Appeals team and assisted in medical necessity appeals
- Managed the Unbilled report to ensure all Claim Retention Criteria Edits (CRC) were corrected and cleared for release of claims
- Managed the Billing Exception Group to ensure all retro patient eligibility and authorizations were obtained for timely filing of claims and reimbursement
- Managed Technical Denials and worked with payers and Utilization departments to submit and overturn the denial decisions as favorable
- Managed the Medical Necessity denials and worked with Utilization department, Hospital Physician Advisors and payers in the submission of the medical necessity appeal to justify the level of care
- Reviewed and approved adjustments to report appropriate contractual amounts as applicable and/or denial adjustments
Governmental Biller → BO Lead - Business Office
Doctors Hospital at Renaissance
01.2011 - 01.2013
- Performed governmental ambulatory billing
- Performed insurance collections and Medicaid and Medicaid Managed Appeals
- Promoted to Lead within the first year and assisted employees with accounts receivable challenges to obtain optimum reimbursement
- Researched payer rules and guidelines to overturn appeal denials
Practice Administrator
Valley Women’s Care
03.2007 - 10.2010
- Practice Administrator of clinic operations and clinic staff
- Managed Quickbooks software for clinic practice and M.D.,P.A. accounts.
- Prepared employee payroll
- Oversaw accounts payable and receivables
- Ordered clinic and clerical supplies
- Ensured physician’s certifications such as DPS, DEA, Physician licenses, Malpractice were updated and posted to CAQH
- Credentialing Coordinator for insurance contacting
- Managed Medical Office Specialists employees in check in and check out functions, appointment scheduling, answering telephone lines, insurance verification/authorizations, patient financial agreements, collecting of Copays, Coinsurance and Deductibles.
- Created clinic patient financial agreements for self-pay and insured patients for surgical & delivery services
- Managed daily cash deposits and petty cash reconciliation.
- Creation of OB/GYN Superbill.
- Posting of daily clinic charges and hospital procedures/coding.
- Posting of insurance payments to patient accounts.
- Reviewing EOBs to appropriately adjust the account and leave the patient with their respective balance
- Prepare patient statements
- Worked A/R for accounts receivable
- Appealed payer denials
- Worked payer correspondence
- Managed payer credentialing
- Managed physician credentialing with hospital and payers
Biller
Women’s Clinic of South Texas
12.2000 - 03.2007
- Performed Medical Office Specialists & Medical Billing functions
- Performed check in and check out duties
- Schedule patient appointments
- Answered incoming calls
- Verified insurance eligibility, obtained authorizations
- Performed patient financial agreements
- Collecting of Copays, Coinsurance and Deductibles
- Managed daily cash deposits and petty cash reconciliation
- Posting of daily clinic charges and hospital procedures/coding
- Posting of payments from insurance companies to patient accounts and adjusting accounts accordingly with contractual adjustments, leaving patients with respective copays, coinsurance, deductible and non-covered amounts and prepared
- Mailed patient statements
- Managed physician credentialing
- Worked payer correspondence, payer appeals, A/R collection follow up, posted payments to legacy system,
Insurance Collector
Rio Grande Regional Hospital
01.1998 - 08.2000
- Performed customer service duties
- Answered incoming patient calls in regards to their patient balances
- Promoted to Insurance Collector and performed A/R collections on facility accounts
Registration Representative
Edinburg Regional Medical Center
01.1996 - 01.1998
- Performed registration functions
- Performed emergency room and admitting registration functions
- Collected patient copays, coinsurance and deductibles
- Prepared daily cash deposits
Education
Data Entry
South Texas Vo-Tech
01.1995
Skills
- Proficient in payer rules and guidelines
- Payer reimbursement analysis
- Experience analyzing EOBs and ERAs
- Insurance verification expertise
- Strong understanding of medical terminology
- Skilled in utilizing functionalities of Paragon, Change Healthcare, Cerner, and AEOS
- Experience with billing rejections and resolutions
- Skilled in accessing claim status and insurance eligibility
- Skilled in tracking and reporting denial management metrics
- Skilled in departmental process optimization
- Team management skills
- QA performance analysis
- Microsoft Office proficiency
- Unbilled services tracking
- Daily cash management
- General office duties
Timeline
Contract Manager
Doctors Hospital at Renaissance
07.2019 - Current
Revenue Cycle Educator
Doctors Hospital at Renaissance
06.2016 - 06.2019
Billing & Collections Manager-Business Office
Doctors Hospital at Renaissance
02.2013 - 06.2016
Governmental Biller → BO Lead - Business Office
Doctors Hospital at Renaissance
01.2011 - 01.2013
Practice Administrator
Valley Women’s Care
03.2007 - 10.2010
Biller
Women’s Clinic of South Texas
12.2000 - 03.2007
Insurance Collector
Rio Grande Regional Hospital
01.1998 - 08.2000
Registration Representative
Edinburg Regional Medical Center
01.1996 - 01.1998
Data Entry
South Texas Vo-Tech
Similar Profiles
Harry ReyesHarry Reyes
Human Resources Business Partner at Doctors Hospital at RenaissanceHuman Resources Business Partner at Doctors Hospital at Renaissance
Ramon Resendez JrRamon Resendez Jr
Outreached Phlebotomist at Doctors Hospital at RenaissanceOutreached Phlebotomist at Doctors Hospital at Renaissance
Nora HernandezNora Hernandez
Insurance Verifier at Doctors Hospital at Renaissance Health SystemInsurance Verifier at Doctors Hospital at Renaissance Health System
Moses PonceMoses Ponce
Student Event Staff Volunteer for Gala at Juan Diego Academy- Catholic High SchoolStudent Event Staff Volunteer for Gala at Juan Diego Academy- Catholic High School
Daren Elian BarreraDaren Elian Barrera
Pitching Trainer at Self-employeedPitching Trainer at Self-employeed