Anna Marie Garza
San Antonio,TX
Summary
Ambitious Account Management with proven to take ownership of projects and deliverables and work as effective team contributor. Prioritizes tasks, multitasks, manages time effectively and performs under pressure in fast-paced environment. Strong interpersonal and clear, concise communications skills. Meets tight deadlines while juggling multiple projects simultaneously.
Overview
22
22
years of professional experience
Work History
Account Management-MCO
Solventum
08.2002 - Current
- Verified insurance of patients to determine eligibility.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Adhered to established standards to safeguard patients health information.
- Assisted patients in understanding their insurance benefits, providing guidance on available financial assistance programs when needed.
- Maintained strict adherence to HIPAA guidelines and regulations, ensuring the confidentiality and security of all patient information.
- Review and analyze prayer specific requirements and coverage criteria to determine required documentation (medical records, prescriptions, operative reports, history and physicals) based on billing criteria
- Worked with other departments and KCI field personnel to obtain missing documentation required for placement and / or billing.
- Maintained strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Communicated with insurance providers to resolve denied of authorization's and resubmitted.
- Ensured timely submission for authorization to various insurance carriers, resulting in prompt payment for services rendered.
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Coordinated with other departments to address any discrepancies or concerns related to charge capture or data entry accuracy.
- Served as a subject matter expert on medical billing matters, providing guidance to colleagues on complex cases or unique situations.
- Participated in departmental meetings, sharing insights and ideas for improving overall medical billing efficiency and revenue generation.
- Monitored changes in payer requirements, adjusting billing practices accordingly to minimize disruptions in the revenue cycle.
- Reduced errors in medical billing by meticulously reviewing patient records and ensuring accurate coding.
- Communicated with patients for unapproved authorziations for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
- Educated colleagues on best practices in medical billing, providing ongoing training sessions as needed.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Utilized various software programs to process proper billing (hero, Delair, Claim form fax, sharepoint, payer tool, port)
- Developed customized reports for management review, highlighting trends in key performance metrics such as denial from payer and escalating them the KCI PRA's to have our system update with the correction information.
Education
Certified - Computer Business Administration
National Institute of Technology
San Antonio, TX05.2002
Skills
- Medicare and Medicaid knowledge
- Work Prioritization
- HIPAA Compliance Understanding
- Critical thinking abilities
- Professionalism and Integrity
- Continuous Learning Attitude
- Goal Setting and Achievement
- Ethical Conduct Awareness
- Training and Development Abilities
- Teamwork and Collaboration
- Customer Service
- Multitasking and Organization
Timeline
Account Management-MCO
Solventum
08.2002 - Current
Certified - Computer Business Administration
National Institute of Technology