Overview
Work History
Education
Timeline
Generic

Anay Cohetzaltitla

Santa Ana,CA

Overview

12
12
years of professional experience

Work History

Commercial Collector

Memorial Health Medical Center
08.2018 - 02.2023
  • Investigating & resolving claim denials.
  • Maintaining detailed notes and records on HMO, PPO and trauma accounts in Epic.
  • Responding to and completing appeals for low payments, denials, medical necessity denials.
  • Fulfilling Medical Records requests.
  • Data input.
  • Communicating internally and with external customers to ensure timely review / resolution.
  • Identifying trends and/or root cause of issues, propose potential solutions to management.
  • Evaluating appeal details and propose recommendations based on findings.
  • Maintaining strict confidentiality and adhere to all HIPAA guidelines and regulations.
  • Other duties as assigned by management.

Patient Account Representative

Providence Speech And Hearing Center
01.2017 - 07.2018
  • Enhanced patient satisfaction by promptly addressing inquiries and resolving account issues.
  • Maintained accurate records of all transactions, ensuring timely payments from patients and insurance providers.
  • Identified trends in unpaid accounts, developing targeted solutions for improved revenue recovery.
  • Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
  • Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
  • Conducted regular audits of patient accounts, identifying discrepancies and rectifying errors as needed.
  • Achieved a significant reduction in aged accounts receivable through diligent follow-up efforts with both patients and insurers.
  • Demonstrated adaptability in navigating complex payer guidelines to maximize reimbursement opportunities for the organization.
  • Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
  • Kept up-to-date on industry trends, sharing knowledge with team members to support their professional development and enhance overall performance.
  • Worked with outside entities to resolve issues with billing, claims and payments.
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
  • Stayed calm under pressure to and successfully dealt with difficult situations.

Senior Collections Specialist

IPSS
06.2015 - 05.2016
  • Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.
  • Contributed to the resolution of billing disputes by working closely with insurance companies and patients to clarify charges and payment expectations.
  • Provided compassionate support for patients facing financial challenges, assisting them in navigating available resources and payment options.
  • Coordinated referrals efficiently between primary care providers and specialists, ensuring a seamless patient experience.
  • Handled complex insurance pre-authorization processes accurately, enabling timely delivery of necessary medical services.
  • Provided exceptional customer service to patients, answering questions and addressing concerns.
  • Verified insurance eligibility and coverage for patients.
  • Entered patient demographic and insurance data into electronic medical record system.
  • Resolved billing inquiries and disputes in timely fashion.
  • Investigated insurance claims denials and appeals.
  • Managed a high-volume portfolio, ensuring timely follow-ups and accurate record-keeping for optimal results.

Senior Collections Specialist

Advanced Surgical Partners
06.2014 - 05.2015
  • Follow-up on workers compensation accounts.
  • Worked in call center environment handling manual and automatically dialed outbound calls.
  • Maintained high volume of calls and met demands of busy and productive group.
  • Maintained accurate records of customer accounts, payments and payment plans.
  • Researched billing errors and discrepancies to initiate corrective action.

Medical Collections Representative

CMRE Financial Services
09.2010 - 03.2014
  • Follow-up on medical professional fee billing, Medi-Cal, Medicare, and commercial insurance carriers.
  • Collecting medical invoices from insurance companies and patients who are international visitors to the USA.
  • Make outbound calls and send written correspondence to insurance/patients.
  • Use Industry knowledge to negotiate quick payments and higher settlements with both insurers and patients.
  • Obtain payments from uninsured patients.
  • Develop relationships with international insurance companies in order to resolve invoices successfully.
  • Ensure that all account activity is accurately maintained on a database.
  • Comply with all relevant legislation such as HIPAA, etc.
  • Handle incoming e-mails/telephone calls from clients and other vendors.

Education

Medical Billing And Coding -

Summit Career College
Anaheim, CA
08.2008

High School Diploma - General Studies

Saddleback High School
Santa Ana, CA
06.2007

Timeline

Commercial Collector

Memorial Health Medical Center
08.2018 - 02.2023

Patient Account Representative

Providence Speech And Hearing Center
01.2017 - 07.2018

Senior Collections Specialist

IPSS
06.2015 - 05.2016

Senior Collections Specialist

Advanced Surgical Partners
06.2014 - 05.2015

Medical Collections Representative

CMRE Financial Services
09.2010 - 03.2014

Medical Billing And Coding -

Summit Career College

High School Diploma - General Studies

Saddleback High School

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Anay Cohetzaltitla