Anabell Ploe
Keystone Heights,FL
Summary
Collections and medical billing
Experienced with medical billing processes and leading teams in healthcare settings. Utilizes knowledge of healthcare regulations and coding standards to ensure accurate billing and compliance. Track record of developing efficient workflows and fostering collaborative team environments.
Medical billing professional with extensive experience in healthcare revenue cycle management and team leadership. Known for optimizing billing operations and implementing process improvements. Collaborative and results-oriented, consistently adaptable to evolving needs and challenges. Proficient in medical coding, billing software, and regulatory compliance.
Medical billing professional with strong expertise in managing and optimizing billing processes. Adept at team collaboration, adapting to changing needs, and ensuring accuracy. Skilled in coding, claims processing, and compliance. Known for achieving results and fostering reliable work environment.
Efficient billing professional with 25 years of experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Overview
22
22
years of professional experience
Work History
Medical Billing Lead
St. Vincent's Medical Center Riverside
Jacksonville, FL
01.2022 - Current
- Supervised medical billing team, ensuring compliance with regulations and accuracy in all submissions.
- Developed training programs for new staff, enhancing understanding of billing processes and systems.
- Streamlined billing procedures, improving workflow efficiency and reducing claim denial rates.
- Collaborated with healthcare providers to resolve billing discrepancies and improve patient satisfaction.
- Analyzed billing data to identify trends, implementing strategies that improved financial performance.
- Mentored junior staff on best practices in billing, documentation, and claims submission processes.
- Identified trends in denied claims, addressing root causes to prevent future issues and improve overall success rates.
- Maintained strict adherence to HIPAA privacy guidelines, protecting sensitive patient information at all times during the billing process.
- Conducted regular audits of billing records to maintain compliance with industry standards and regulations.
- Managed accounts receivable aging reports, prioritizing collections efforts for overdue balances.
- Collaborated with clinical staff to ensure accurate coding of procedures and diagnoses for proper claim submission.
Medical Office Secretary
St. Vincent’s Clay Cardiology
Middleburg, FL
09.2006 - 01.2022
- Mentored junior staff on medical office protocols and software usage to enhance team performance.
- Managed patient scheduling and appointment confirmations for enhanced office efficiency.
- Processed medical records and maintained confidentiality in compliance with HIPAA regulations.
- Coordinated communication between healthcare providers and patients to streamline information flow.
- Assisted in insurance claims processing, ensuring accuracy and timely submission for reimbursement.
- Developed training materials for new hires, promoting consistency in administrative practices across the office.
- Verified or obtained referral numbers or authorizations for upcoming appointments.
- Created informative patient brochures about available services offered at the medical practice, enhancing overall satisfaction rates.
- Communicated with outside facilities for scheduling tests or surgeries.
- Promoted a positive work environment by fostering collaboration and open communication among office staff members.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Kept information confidential and followed HIPAA guidelines to maintain patient trust.
- Performed various administrative tasks by filing, copying and faxing documents.
Medical Biller
The Pain Center
Orange Park, FL
12.2003 - 09.2006
- Processed medical claims accurately using advanced billing software and coding systems.
- Ensured compliance with insurance regulations and updated policy changes effectively.
- Collaborated with healthcare providers to resolve billing discrepancies and enhance payment accuracy.
- Analyzed claim denials to identify trends and implemented corrective actions for improved outcomes.
- Contributed to company growth by accurately analyzing trends in denial rates, payer mix, and other key performance indicators relevant to revenue cycle management.
- Boosted customer satisfaction through professional handling of patient inquiries regarding billing matters and insurance coverage.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Liaised between patients, insurance companies, and billing office.
- Prepared billing statements for patients and verified correct diagnostic coding.
Education
High School Diploma -
C.E.T.A. Program
Santa Paula, CA06-1981
Business Administration
Ventura Community College
Ventura, CA01-1986
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Santa Paula High School
01.1983
Skills
- Medical billing software proficiency
- ICD-10 knowledge
- Organizational growth
- Claims processing proficiency
- Critical thinking
- Team leadership
- HIPAA compliance
- Collections experience
- Electronic health records experience
- Analytical problem solving
- Accounts receivable management
- CPT coding
- Payment posting
- Denial management expertise
- Patient billing procedures
- Teamwork and collaboration
- Problem-solving
- Attention to detail
- Self motivation
- Billing and invoicing
- Computer literacy
- Professionalism
- Goal setting
- General ledger entries
- Organizational skills
- Excellent communication
- Reliability
- Task prioritization
- Work Planning and Prioritization
- Adaptability
- Records research
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Achieved 80% success by introducing insurance billing spreadsheets for referrals/authorizations tasks.
- Supervised team of 7 staff members.
- Achieved through effectively helping with A/R.
- Achieved clean claims with accuracy and efficiency.
- Collaborated with team of 7 in the development of clean claim submission.
- Documented and resolved problemitc claims which led to full reimburstment.
Languages
Spanish
Native or Bilingual
Timeline
Medical Billing Lead
St. Vincent's Medical Center Riverside
01.2022 - Current
Medical Office Secretary
St. Vincent’s Clay Cardiology
09.2006 - 01.2022
Medical Biller
The Pain Center
12.2003 - 09.2006
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Santa Paula High School
High School Diploma -
C.E.T.A. Program
Business Administration
Ventura Community College
SUMMARY OF QUALIFICATIONS
- Twenty years of experience in the medical field encompassing:
- Supervisor of collections and billing Responsible for
- Insurance billing, collections, coding/Procedures using Westland, Medical Manager and Athena software systems.
- Medicare, Medicaid, BCBS and private insurance billing.
- Handle negotiations with insurance companies for denial claims, request for review and hearings.
- Computer input including accounts receivables, posting checks, EOBS, Surgery scheduling, daily office/Hospital charges.
- Heavy telephone and appointment scheduling.
- Fluent in Spanish
PERSONAL STRENGTHS
Handle pressures and work well as a member of a team. ...Self directed with excellent ability to communicate with doctors, insurance companies, patients and office personnel...Dependable....Pleasant.