Alia Abrescy Martinez
Merced,USA
Summary
Equipped with problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
13
13
years of professional experience
Work History
Credentialing Specialist /Medical Biller
Apex Medical Group
10.2015 - Current
- Obtain information from new incoming providers for credentialing
- Accessible to all providers should have any questions or concerns during the credentialing or re-credentialing process
- Complete new applications on paper or online for new providers for all tax ID's numbers and locations
- Keep in communication with insurances on provider's application status until application is completely processed
- Complete re-applications for established providers for all four clinics
- Attest, maintain and update all providers profile and insurances as required
- Maintain current provider and office licenses on file
- Responsible for updating W9's yearly
- Responsible for maintaining current malpractice on file with insurances as request
- Take phone calls from 3rd party companies requesting to verify provider or company information for their directories and/or websites
- Submit notices to various insurance companies when a provider leaves practice to have provider removed from rosters
- Enter new providers into EMR system
- Enter new departments in EMR system when required
- Keep provider and clinic information updated in EMR system
Medical Biller
Apex Medical Group
10.2011 - Current
- Experience working with Athena Health (EMR)
- Submit medical claims for RHC, Remote Patient Monitoring, Nursing home and Assistant living homes
- Help answer phones
- Assist patients with billing or insurance questions
- Verify insurance eligibility
- Obtain referral/authorizations when needed
- Experience with Medicare, Medi-Cal, Managed Medi-Cal, HMO, EPO and PPO insurances
- Correct claims and send back for reprocessing when denied
- Responsible for setting up new co-workers with insurance login access for various insurances
- Responsible for processing mailed in insurance/patient payments
Skills
- Provider enrollment
- Data Management
- Provider Relations
- Application coordination
- Insurance procedures
- Procedure Compliance
- Problem-Solving
- Time Management
Timeline
Credentialing Specialist /Medical Biller
Apex Medical Group
10.2015 - Current
Medical Biller
Apex Medical Group
10.2011 - Current
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