ANDREA AGUIRRE
Kerrville,TX
Summary
Knowledgeable Billing Representative familiar with Billing processes practices and compliance requirements. Excellent customer service and problem solving abilities. Offering 14+ years of experience and the drive to excel in all areas. Confident Biller with great knowledge of multi specialty skills and more than 10+ years of experience. Effective team player known for reliability and quick work. Dedicated to accuracy and efficiency. Detail-oriented and methodical Medical Claims Professional offering 10+ years of experience in related roles. Exceptional abilities in prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills and superior work ethic for top job performance.
Overview
3
3
years of professional experience
Work History
Biller, Billing Rep
Optum-West Med Medical Group
Charlotte , NC
2022.01 - Current
- Internal Medicine, Family Medicine, Pediatrics, Orthopedics, Endocrinology, Nephrology, Anesthesiology Allergy, Immunology and Pediatric Endocrinology, General Surgery, Gastro, Physical Therapy, Laboratory
- Researching errors by comparing billing error reports against system information along with CMS (Center for Medicare and Medicaid Services) records
- Sending correspondence to members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections
- Reconciling reports
- Performing basic clerical functions with proficient PC skills
- Analytical and Researching techniques to trend or quantify projects
- Initiate and assist with developments/changes to increase or change quality and productivity
- Responding to member premium billing questions & verify enrollment status
- Working with various types of member correspondence
- Reconciling billing discrepancies, analyzing transactional data & submitting retroactive billing changes
- Inventory control of member transactions dashboard and package development to team members and management as needed
- Access all portals to obtain EOBs/ERA
- Check hospital charges for providers
- Ensure/Verify source date us valid for billing and that it will be submitted to correct payer
- Reconcile 5+ discrepancies identified within customer invoice/billing
- Review/resolve claim edits prior to submission
- Keying claims into insurance portals for payment
- Uploading medical records to insurance companies.
- Reviewed and solved account and billing discrepancies
- Executed billing tasks and recorded information in company databases
- Assessed accounts for payment status and reached out to customers
- Followed up with appropriate parties to obtain prompt payments
- Received incoming information and entered into database system
- Checked insurance eligibility by making appropriate phone calls and conducting research on services rendered
- Coordinated with intermediate parties to obtain payments and resolve issues
- Kept all patient information secure and confidential
- Completed and processed purchase orders and customer invoices each quarter
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments
Billing Office Coordinator
Hill Country Primary Care Physicians
Fredericksburg , Texas
2019.06 - Current
- Multi Specialty Group
- Lockbox payment posting JP Morgan
- Assist patients with hospital billing/Medical Group questions
- Bank reconciliation for all payment sources throughout entire medical group
- Employee deductions for payroll set up
- Responsible in playing pivotal role in ensuring patient have great experience from moment walk through door to when leaving office
- Coordinate and help oversee operations of clinical and front office functions to provide patients with high quality, patient-centered care
- Serve as team leader with all front office functions including patient relations check-in/check-out, scheduling, insurance verification, and answering phones
- Assist nurse/medical assistant with obtaining authorizations for in office and out of office procedures and surgeries from insurance companies
- Ensure any patient complaints are handled appropriately for maximum patient benefit and organizational success
- Develops guidelines for prioritizing work activities, evaluating effectiveness and modifying activities as necessary to ensure appropriate staffing levels are maintained
- Conducts daily huddles to organize work tasks with team
- Watching for trends and educating physicians on accurate coding and billing guidelines
- Manage filing and retrieving medical records and patient information
- Performs and ensures timeliness and accuracy of patient charge entry into practice management system and clearing house, and assists with collecting and recording co-pays
- Coordinate receipt of all applicable deductible, co-insurance, and co-pay amounts from patients for their procedures and surgeries
- Prepares all physician expense reports, obtains appropriate leadership signatures, and submits to accounting for processing
- Assist medical group leadership with completing facility credentialing paperwork, for all assigned providers
- Assist with Revenue Cycle and work back-office operations directly through eClinicalWorks application, securely and accurately
- Ensure all documentation meets billing guidelines for CPT codes selected
- Work all follow ups AR for multi-specialty groups, Scrub, and clean claims for accurate claims submission
- Work AR and denial reports in timely manner
- Work collections console and collections portal
- Assure that all incomplete encounters are cleaned and fixed for providers
- Assure providers meet ACO requirements with Annual Wellness exams
- Completes billing process
- Billing/Revenue Cycle
- Verify that daily reconciliation has been completed for all assigned receptionists
- Input day sheet numbers on accounting spreadsheet
- Review all claims denials/RCM requests, Review LCDs/Payer policies with provider education as needed
- Review and processing payer refund requests, Verify/update patient information as requested by RCM, Review and submit claims for adjustment/voids, Work eligibility edits, process claim edits in encounter review status, notify providers of unlocked and incomplete encounters, Run reports weekly for trends
- Post payments in system
- Add old A/R payments to spreadsheet to transfer to old system
- Review tasks daily for completion or action needed
- Review patient inquiries and amount owed by patient
- Process/posting patient payments Process patient refunds as appropriate
- Set up payment plans/move patient payment plan to status as appropriate
- Utilize patient estimate form
- Pull appropriate charges per facility from fee schedule
- Inform patient of estimated charges
- Collect patient estimate and set up payment plan prior to procedure
- Review patients in payment plan status
- Move patients in default status to collections
- Review provider specific incomplete encounters weekly
- Review encounters for accuracy
- Notify providers of incomplete encounters as appropriate
- Educate providers and staff of new company protocols.
Education
Associate of Science Degree - Medical Billing And Coding Associate of Science De
Ultimate Medical Academy
Florida City, FL08.2017
Skills
- Financial Transactions-Start to Finish
- Claim Processing-Start to Finish
- Account Posting
- Excellent Communication
- Accounts Payable and Accounts Receivable
- Verbal, Written, Via Telephone and Front Desk patient services.
- Referrals & Medical Records
- Billing and Collection
- Data Entry & Processing of Payroll
- Computer Skills
- Strong understanding of EOBs
- Daily Reconciliation of collections collected daily.
- Excellent leadership abilities to react with appropriate levels of urgency to situations, and events that require quick response to exercise good judgment and discretion with demonstrated ability to think creatively and strategically.
SOFTWARE-PROFICIENT
- E Clinical Works, Athena, Centricity, Connex, EPACES, CT Medicaid, EPAY, Chase, IQ,CDS Desk top fax, Intelligent medical software with Aims, Implementation of Athena Health EMR, Meditech, Availity, Allscripts, Transact RX, PECOS & NPPES Registry, CAQH and Death Certificates (TER), One drive, Fax age electronic faxing, Greenway, Fax age, one drive CTMS-Real time System, E-Clinical Works. Various insurance portals. Appeal claims, Insurance Verification, CPT, ICD-9/10 coding/HCPC, Medical Terminology, Collections, Medicare/Medicaid, HIPAA/OSHA, AR/Collections, Medical Billing, Pre-Certification/authorizations, post patient payments, H.H. Certifications, HMO & PPO insurance, Deposits.
EARLIER CAREER PROFESSIONAL EXPERIENCE
Santé Clinical Research- Clinical Research Coordinator- Kerrville, TX 03/06/2016-04/12/2019
Colgin & Hurley Internal Medicine- Clinic Office Manager-Kerrville, TX 03/01/2009-03/04/2016
Peterson Regional Medical Center- Patient Financial Coordinator-Kerrville, TX 01/17/2006-02/27/2009
REFERENCES
Pamela Henry- Billing Manager- 808-228-3220
Linsey Banks- Lead Biller- 720-231-6586
Elizabeth Harwonski-Revenue Cycle Manager-806-252-3030
Kirsten Womack- Revenue Cycle Coordinator- 830-385-5206
Timeline
Biller, Billing Rep
Optum-West Med Medical Group
2022.01 - Current
Billing Office Coordinator
Hill Country Primary Care Physicians
2019.06 - Current
Associate of Science Degree - Medical Billing And Coding Associate of Science De
Ultimate Medical Academy
Similar Profiles
Orhun Serhat YararOrhun Serhat Yarar
Caisson Superstructure Construction Works Manager at Nador West Med Port Project, STFA Construction GroupCaisson Superstructure Construction Works Manager at Nador West Med Port Project, STFA Construction Group
Ivette WoodsIvette Woods
Medical Billing Specialist at RIVESIDE MEDICAL GROUP- UNITEDHEALTH GROUP OPTUMMedical Billing Specialist at RIVESIDE MEDICAL GROUP- UNITEDHEALTH GROUP OPTUM
Clamarys De Los SantosClamarys De Los Santos
Office Manager at All Med Medical GroupOffice Manager at All Med Medical Group