RCM AR Specialist
WebPT – Phoenix, AZ 03/04/24-Present
RCM AR Specialist.
Submit claims to payors in accordance with payor requirements and agency policy.
Receive notices of claim rejections and denials.
Properly track and resolve issues to ensure claim payment.
Performs troubleshooting for billing error codes/modifiers.
Work with the Payer or Branch Operations team to identify and resolve issues.
Analyzes daily reports from the State and matches the approved payments to the client.
Alert the Operations team and Manager regarding late or missing documents required for billing.
Review EOBs to determine accuracy of payment and/or overpayment.
Produces reports as needed.
Congress Medical Associates – Arcadia/Pasadena, CA 08/22-02/29/24
Pre-Certification/Eligibility & Benefits Coordinator
Maintain patient demographics and update information as needed.
• Verify patients' eligibility and benefits utilizing insurance portals and/or speaking with Utilization Management.
Check doctor's orders and request pre-certification based on CPT/DX codes.
Upload and/or fax clinicals and all pertinent information for pre-certification approval.
Partner closely with physician assistant, medical assistants, schedulers, and collectors.
Handle patient, hospital, and doctor's office inquiries.
Schedule Peer 2 Peer.
File for appeals.
Handle retro authorization inquiries.
Problem Solving.
Train as needed.
Maintain strict patient confidentiality and adhere to all HIPAA guidelines and regulations.
United Medical Imaging - West Covina, CA, 05/21-08/22
Eligibility and Benefits Coordinator
Maintain patient demographics information.
Verified insurance eligibility for radiology modalities for upcoming appointments, utilizing online websites or contacting the carriers directly.
Reviewed patient deductibles and co-pays. Advised patient of their responsibility.
Answer questions from patients, insurance companies, doctors' offices, and clerical staff regarding scheduling and if authorization was needed.
Performed job-related duties as assigned.
Maintain strict patient confidentiality and adhere to all HIPAA guidelines and regulations.
Brault Solutions, San Dimas, CA, 05/19-02/21
Patient Services Billing Representative.
• Prepared and submitted claims to insurance companies electronically and by mail (paper-claims).
Handled patient inquiries and answered questions from patients and insurance companies.
Identified and resolved patient billing problems, and assisted patients with payment plans.
Prepare adjustments, reversals, and refunds as necessary.
Processed rejected claims by researching errors in Availity.
Maintain strictest confidentiality and adhere to all HIPAA guidelines and regulations.
FutureNet Technologies, Diamond Bar, CA, 06/04-02/19.
Transcription Supervisor/Client Liaison
Supported and managed a large team of medical transcriptionists and medical editors.
Directly responsible for customer turnaround time and quality satisfaction.
Help maintain over 20 hospitals and 10 clinic accounts.
Driven to maintain consistent achievement of 95% document turnaround time and 95% document quality, resulting in many satisfied customers.
Problem solving and customer satisfaction.
Communication exposure ranged from doctors to medical assistance to HIM. Directors and medical records departments.
Instituted and hosted team quality calls and training programs.
Managed and provided daily support.
Conducted biweekly baseline analysis to ensure attainment of goals.
Coached and mentored MT staff, working through performance management processes as needed.
Partnered closely with Human Resources, Account Management, Project Management, and customer service teams.