Alma Ramos

Processed medical and hospital Medicare claims.

Resolved, rejected, denied, and error claims.

Verified provider network status.

Entered high-dollar amount claims for review in the hospital.

Verified authorization and attached it to claims.

Verified patient insurance eligibility.

• Billing Specialist /Authorization Coordinator for Home Healthcare and Pediatrics for the states of Idaho and Utah
• Processed claims and reviewed daily charges, revenge cycle process
• Resolved rejected, denied and error claims
• Resolved Complex payment issues with insurance companies
• Resolved large backlog of past due claims aged two years or older
• Assisted Idaho and Utah agencies with insurance questions and set-up patient
• Set up patients in HCHB and AMD systems, and Verify patient charts
• Created patient statements
• Accounts Receivable Follow up. Reviewed authorization for payment.
• Obtained authorization for Home Health Care, Home Health Aide, Home Health Maker and skilled nursing Services for Medicaid and Veteran Affairs plans
• Obtained authorization for pediatric therapy services and skilled nursing services for Medicaid

• Process Medical chart notes
• Verified patient insurance eligibility and benefits
• Obtained and processed insurance prior authorization for patient referrals to specialists
• Provided assistance to triage nurses and physicians
• Assisted with patient collection process including payment plans, or as liaison to collection agencies
• Process patient monthly statements and collection letters
• Collected and processed payments
• Balanced front desk co-pays and prepare daily deposit
• Assisted clinic administrator with accounts payable.