Ana Luisa Garza, CPC
San Antonio,TX
Summary
Professional in claims management, equipped to drive accurate and efficient claim resolutions. Proven track record in handling diverse cases and ensuring compliance with regulatory standards. Known for strong team collaboration and adaptability, bringing valuable problem-solving skills and reliability to every project.
Overview
2
2
Languages
1
1
Certification
9
9
years of professional experience
Work History
Claims Examiner I - Hartford Voluntary
WebTPA
San Antonio, TX
06.2025 - Current
- Handled claims processing and adjudication for supplemental accident policies.
- Reviewed and researched medical records and documents to identify benefits covered under member policies
- Considered each claim submission to assess maximum benefits allowed, ensuring accurate payouts
- Review group policy booklets for benefit definitions and benefit amounts payable as well as any exclusions that may apply
- Go through documents with care to also detect and identify potential fraud
- Evaluated medical record submissions to ascertain additional benefits payable for ongoing accidents
- Handled all claims efficiently and timely as promised to clients and their members.
- Utilized knowledge of CPT and ICD-10 guidelines to properly translate performed services/procedures into numerical code for insurance company reimbursements
Outpatient Coder / Practice Coordinator (Admin)
Northeast Orthopaedics & Sports Medicine
San Antonio, TX
02.2018 - 05.2025
- Managed claims work list, effectively appealing denials via phone, fax, and website portals
- Read and interpret hospital consultations/operative reports in order to submit professional charges using CPT/ICD10 Coding guidelines
- Maintaining a 98% accuracy rating during claim/coding monthly auditing
- Analyzed provider notes and operative reports to resolve coding discrepancies and reduce claim rejections.
- Audited outpatient charts for documentation completeness, accuracy, and reimbursement integrity.
- Utilized knowledge of CPT and ICD10 guidelines to properly translate performed services/procedures into numerical code for insurance company reimbursements
- Read and interpret hospital consultations/operative reports in order to submit professional charges using CPT/ICD-10 Coding guidelines
- Assist with claims work list, appealing claim denials by phone, fax and website portals
- Work on appeals for denied authorization requests for diagnostic imaging, viscosupplementation injections and elective surgeries
- Verify if authorization is needed for studies and obtain if required
- Obtaining PreAuthorization/Referrals for Viscosupplementation injections if required
- Verified benefits and assessed costs for Viscosupplementation injections using fee schedules to ensure accurate billing
- Submit prescriptions for Viscosupplementation injections to Specialty Pharmacies
- Receive orders from physicians for all radiology imaging requests, nerve conduction studies, elective outpatient surgeries and all Viscosupplementation injections
- Monitored coding quality trends and implemented process improvements for workflow consistency.
- Scheduled patients for injections per ordering physician guidance
- Collaborated with administration team to submit IT/EMR access tickets and resolve arising issues efficiently
- Able to assist proficiently with daily front office and back office operations
- Assist with referral department operations (scheduling, requesting new referrals, etc.)
- Assist with referral department operations (scheduling, requesting new referrals, etc.)
- Assist with collecting FMLA document fees and other fees as needed
- Assist Physical Therapy department with benefits and obtaining authorizations for treatment
- Assist in training other individuals
- Trained new team members on operational procedures
- (Baptist Medical Network)
- (Baptist Medical Network)
- Reviewed orthopedic and sports medicine encounters to assign accurate ICD-10-CM, CPT, and HCPCS codes.
Call Center Representative
UT Health Science Center At San Antonio
San Antonio, TX
09.2017 - 02.2018
- Answer all incoming calls for the Neurology department
- Updated registration and benefits information for patients before appointments to ensure accuracy and compliance
- Created and updated referrals and verified active coverage for new patient appointments to facilitate smooth patient processing
- Create new patient charts and attach medical records for the physician to review Assist LVNs with patient messages and phone calls
- Scheduled EMG procedures and managed incoming orders to optimize workflow and service delivery
- Assisted in Neurology department operations.
Education
Associates Degree - Healthcare Administration
St. Philip's College
San Antonio, TX01-2019
Skills
- Claims processing
- CPT and ICD-10 expertise
- Encoder Pro and Cerner
- EMR systems proficiency
- Inbound call management
- Bilingual communication
- Claims adjudication
- Coding methodologies
Certification
Certified Professional Coder - AAPC
Languages
English
Spanish
Timeline
Claims Examiner I - Hartford Voluntary
WebTPA
06.2025 - Current
Outpatient Coder / Practice Coordinator (Admin)
Northeast Orthopaedics & Sports Medicine
02.2018 - 05.2025
Call Center Representative
UT Health Science Center At San Antonio
09.2017 - 02.2018
Associates Degree - Healthcare Administration
St. Philip's College