Antoinette Montoya
Kansas City,MO
Summary
Resourceful and seasoned medical professional focused on patient care and customer service. Strong work ethic, adaptability, and exceptional interpersonal skills. Demonstrated abilities to resolve even the toughest challenges.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Patient Account Representative
Liberty Hospital
Liberty, MO
09.2023 - Current
- Provided customer service to patients regarding billing inquiries and account information.
- Analyzed claims denials from third party payers and identified potential solutions for reimbursement.
- Researched discrepancies in patient accounts to determine appropriate resolution.
- Verified accuracy of medical coding for services rendered by healthcare providers.
- Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
- Updated existing patient files with relevant information such as changes in address or contact information.
- Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
- Collaborated with relevant parties to resolve billing issues, insurance claims and patient payments.
- Maintained detailed notes on all patient interactions for future reference purposes.
- Worked closely with insurance companies to obtain authorization for services rendered.
- Submitted appeals on behalf of patients when appropriate based on findings from research conducted into denied claims.
Senior Staff Assistant
Kaiser Permanente
San Jose, CA
02.2021 - 03.2023
- Under limited supervision, provides advanced level administrative support
- Typically reports to a director or head of a department
- Performs complex administrative duties, often without established procedures and precedents
- Contacts are frequent with individuals representing other departments and outside organizations
- Essential Responsibilities: Organizes and expedites the flow of work for the manager or the department and initiates any follow-up action
- Frequently accesses highly confidential and sensitive information; handles such information with judgment and tact
- Arranges large conferences and meetings, including securing the rooms, equipment and presentation materials; coordinates all logistics so that events run smoothly
- Maintains manager's calendar and occasionally makes travel arrangements
- Performs other calendar-related or scheduling duties as needed
- Prepares special reports and presentations that require data gathering, and comparing and summarizing data
- Helps on-board new employees; may provide training
- Creates spreadsheets and graphics for presentations
- Performs data input and maintains established databases; ensures data is accurate
- Monitors the department budget; tracks and complies expense reports
- Purchases department supplies and manages inventory
- Submits and tracks department invoices
- Submit and track EVS/Engineering/Facilities' needs
- Prepares and corrects timecards
- Tracks employee attendance
- Prepares documents for the manager from established templates, including meeting notes
- Receives and screens telephone calls or visitors
- Answers questions and provides information related to general department operations, policies and procedures using discretion for matters pertaining to confidential or sensitive information
- May maintain the department's website
- Performs other related duties as assigned.
Admitting Specialist
Kaiser Permanente
San Jose, CA
02.2016 - 02.2021
- A patient service professional responsible for coordinating & completing every phase of the admission function including admissions, preadmission's, interviews for financial & demographic information, obtains & processes advance directives, obtains patient/agent signatures, may initiate valuables collection & distribution, document preparation for all elective, direct &/or emergency admissions, revenue collection in all settings, & data retrieval
- Assures confidential treatment of all communications written & verbal
- Will initiate & maintain patient room assignments & status until discharge
- Acts as a primary informational resource & provides assistance to both internal & external customers
- The Admitting Representative must be capable of making decisions & working independently to achieve all departmental functions, as well as maintain an in-depth understanding of job duties & changes as admitting decisions have significant financial & medical implications
- Essential Functions: Instruct & review with patient, information concerning hospitalization
- Ascertain health plan status, research eligibility & collect & copy non-KP insurance information
- Identifies all uninsured or under-insured patients admitted to facility; refer to Financial Counselors for further action
- Obtains verification & necessary pending authorizations from non-KP insurers (including Medicare, Medi-Cal & COB) on members & non-members when Financial Counselor is not available
- All documentation is completed in the Member Integrated Tracking System (MITS) or the appropriate KP tracking system
- When Financial Counselor is available, discusses the need to obtain authorizations from non-KP insurers
- Promote patient satisfaction & retention through the successful facilitation of the revenue collection process
- Calculate member liability based on benefit plan
- Inform patient/agent & collect appropriate cost share payments for services rendered in all settings (e.g
- Bedside, follow up phone calls to patient's home, etc.)
- Notify patient & when possible collect financial liability for elective procedures & document all interactions
- Contact all discharged patients to attempt collection of financial liability & document all interactions
- Research payment records of all non-paying patients with liabilities, utilizing system records
- Reports findings to Manager/Supervisor/Designee
- Analyze revenue data to determine obstacles in cost share collections
- Collects all information necessary to bill second-party payers
- Interview patients for pre-admission or admission to the hospital, collecting personal, demographic, financial, & medical information in person or by phone per KP policies
- Enter complete data into the KP information systems & review for accuracy per department, local, regional, & regulatory compliance
- Affix identification bracelet to the patient's wrist on the side of the body opposite the intended procedure or injury per local policy
- Understand & abide by the HIPAA regulations & KP Corporate Compliance.
Teleservice Representative
Kaiser Permanente
San Jose, CA
06.2015 - 02.2016
- Handled incoming calls from all of our Northern California members
- They call in to set up appointments, reschedule, talk with the nurse or doctor, call for basic questions or refill medications
- Took emergency calls as well for chest pain or car accidents seeking help
- Took well over 150 calls per day, every call is different depending on the needs of the patient
- Evaluated patient care needs, prioritize treatment, and maintain patient flow.
Pharmacy Technician
Optum RX
Overland Park, KS
06.2011 - 08.2014
- Provide up-to-date information concerning admission & hospital practices & administrative procedures per HIPAA guidelines
- Evaluate & attempt to resolve/refer public & patient concerns as they arise
- Facilitate the timely admission of patients throughout the hospital by coordinating patient information w/the physicians, Emergency Room, Clinic Departments, House Nursing Supervisor, Patient Care Unit Staff, & outside Care Coordinators per local policy
- Receive admission requests
- Facilitate appropriate bed assignments & communicates information to staff
- Maintain accurate record of cost share status of all patients with liabilities, utilizing revenue tracking system as determined by management
- Obtain appropriate signatures on permits & consents per California Hospital Association (CHA) consent guidelines
- Prepare related admission paperwork in advance to facilitate a timely admission process
- Assemble & coordinate admission materials to create a comprehensive admission package
- Receive, document, secure & release patient valuables according to Standard Procedure 18A as appropriate
- Initiate membership records on all newborns per local policy
- Distribute admission materials to proper locations
- Participate in problem-solving as needed to assure organizational revenue targets & customer satisfaction
- Escort or arrange for patient escort to assigned room or area per local policy
- Answer phones in a professional, courteous & positive manner promoting excellent customer relations when providing information/directions to physicians, staff & public
- Maintain high standards of excellence & assist Kaiser Permanente fulfill its mission by providing high-quality health care services
- Work in a team environment continually enhancing required skills through scheduled training sessions or individually
- Attend required meetings, workshops & in-services
- Provide support in conducting audits depending upon supervisory need.
Pharmacy Technician
Aetna RX Home Delivery
Kansas City, MO
02.2008 - 09.2010
- Performed technical processes required to dispense medications to patients
- Completed new and updated patient profiles, including lists of patient medications
- Receptively answered customer questions and helped locate desired items in the pharmacy
- Assisted the pharmacists with checking in and pricing drug orders, third party transactions and relevant paperwork
- Correctly completed pharmacy paperwork, including daily and weekly reports
- Worked closely with Pharmacy Care Representatives (PCRs) in providing excellent patient care
- Received and accurately processed written prescriptions from customers using Rx EVO computer system
- Properly filled and dispensed an average of 100 prescriptions per day
- Regularly stocked shelves, rotated stock and checked for expired medications.
Collections Representative
Citi Bank
Kansas City, MO
08.2007 - 01.2008
- Took incoming calls from customers wanting to make payment, or set up arrangement on account owed
- Maintained a certain number of collections depending on goals for the month
- Closed accounts when payment balance reached zero.
Emergency Dispatcher
ADT Security Systems
Kansas City, MO
02.2006 - 05.2007
- Worked on a dialer receiving emergency alarms
- Received calls seeking emergency dispatch/rescue
- Dispatched police, fire, and or rescue
- Stayed in communication with dispatch in case of cancellation.
Education
Completed Coursework Towards In Associate Of Science General Studies -
Maple Woods Community College
Skills
- Hospital Experience (8 years)
- Administrative Experience (6 years)
- Order Entry (9 years)
- Excel (5 years)
- Citrix (8 years)
- Word Processing
- Certifications and Licenses
- Pharmacy Technician
- Patient-focused care Word processing
- Seasoned in medical clinical procedures
- 56 WPM typing speed
- Excellent interpersonal skills Articulate and well-spoken
- Natural leader Flexible
- Analytical thinker Maintains confidentiality
- Calm under pressure Independent worker
- Staff Planning
- Employee Timesheet Processing
- Customer Relationships
- Advanced Excel Spreadsheet Functions
- Office Support
- Administrative Management
- Staff Development
- Office Supplies and Inventory
- Quarterly Reviews
- Office Meetings
- Database and Client Management Systems
- Multitasking and Time Management
- Staff Orientation and Training
- Medical Billing
- Insurance Verification
- Physicians' Orders
- Medical Terminology
- Administrative Support
- HIPAA Understanding
- Payment Processing
Certification
- Medical Terminology
Timeline
Patient Account Representative
Liberty Hospital
09.2023 - Current
Senior Staff Assistant
Kaiser Permanente
02.2021 - 03.2023
Admitting Specialist
Kaiser Permanente
02.2016 - 02.2021
Teleservice Representative
Kaiser Permanente
06.2015 - 02.2016
Pharmacy Technician
Optum RX
06.2011 - 08.2014
Pharmacy Technician
Aetna RX Home Delivery
02.2008 - 09.2010
Collections Representative
Citi Bank
08.2007 - 01.2008
Emergency Dispatcher
ADT Security Systems
02.2006 - 05.2007
Completed Coursework Towards In Associate Of Science General Studies -
Maple Woods Community College