April Martinez
Houston
Summary
Proven Medical Billing and RCM Specialist fluent in English and Spanish language with a track record of enhancing revenue by adeptly managing accounts receivables and minimizing write-offs for Texas Hearing Institute. Skilled in customer service and proficient in Athena and IMS, demonstrating a keen ability to resolve billing inconsistencies and streamline patient financial processes. Strong leader and problem-solver dedicated to organizing operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Skilled Medical Billing Specialist with background in accurate coding, claims processing and managing patient accounts. Showcased proficiency in medical software systems, healthcare regulations, and insurance policies. Proven ability to streamline billing procedures leading to increased productivity and improved revenue cycle management. Known for strong problem-solving skills and commitment to maintaining confidentiality in handling sensitive patient information.
Overview
15
15
years of professional experience
Work History
Medical Billing Specialist
Texas Hearing Institute
Houston
06.2022 - Current
- Focus on maximizing revenue and reducing contractual allowances and write offs.
- Verify insurance of patients to determine eligibility.
- Research and resolve billing inconsistencies and errors through individual and collaborative analysis.
- Liaison between patients, insurance companies, and billing office.
- Obtain prior authorizations for medical services including Hearing Aids and medical appointments and procedures.
- File and update patient information and medical records.
- Evaluate patient’s financial status and establish appropriate payment plans.
- Precisely evaluate and verify benefits and eligibility.
- Examine patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Follow reimbursement procedures when patient overpays, insurance overpays, or insurance recoups.
Medical and Dental Billing Specialist
Legacy Community Health
Houston
11.2018 - 02.2022
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Maintained accurate records of customer payments.
- Collaborated with customers to resolve payment disputes.
- Kept detailed and correct documentation of payments, charges, and write-offs.
- Reconciled up-to-date details of patient financial responsibilities, fee-for-service, and managed care plan.
- Verified accuracy of accounts payable payments, resulting in 76% reduction in payment errors and check reissues.
Patient Account Representative
Midwestern University Dental Institute
Downers Grove
01.2014 - 09.2018
- Prepared reports detailing billing actions, flags and other key information.
- Monitored customer accounts for payment delinquency and initiated collection efforts.
- Utilized computer programs to create invoices, letters, and other documents.
- Responded to patient, family, & external payer inquiries.
- Posted payments and processed refunds.
- Worked with outside entities to resolve issues with billing, claims, and payments.
- Responded to customer inquiries and provided detailed account information.
- Processed debtor payments and updated accounts to reflect new balance.
Patient Services Coordinator
Fort Bend Family Health Center
01.2011 - 01.2012
- Scheduled appointments to enter appointment date and time into computerized scheduler.
- Collected patient co-pay and issued receipt to confirm payment.
- Completed clerical duties and tasks for clinic administration.
- Managed multi-line phone system and pleasantly greeted patients.
- Verified and updated demographic and other personal information for clients with respect to personal boundaries when asking for relevant details.
- Maintained current and accurate medical records for patients.
- Supported office staff and operational requirements with administrative tasks.
- Remained aware of provider schedules and scope of practice on evolving basis to organize and schedule appropriate care.
Education
GED -
Morton College
Cicero, ILSkills
- Accounts Receivables
- Customer Service
- Prior Authorizations
- Medical Billing/RCM
- Claims Processing
- Claims Review
- Collection calls
- Collections Management
- ICD-10
- Athena
- IMS
- Dentrix
- Microsoft 365
- Insurance Verification
- Teamwork and Collaboration
- Claims processing
- Revenue management
- Insurance verification
- Patient billing
- Healthcare compliance
- Account reconciliation
- Data entry accuracy
- Problem solving
- Attention to detail
- Denial management
- Bill payment
- ICD-10 proficiency
- Medicare and medicaid process
- CPT knowledge
- Collections management
- Claim submission
- Payment posting
- Accounts payable
- HIPAA compliance
- Electronic health record software
- Insurance collections
- Submission of medical claims
- Electronic claims
- Claim review
- Medical record security
- Billing codes
- Medical claims submission
- Verbal and written communication
- Medical terminology
- Insurance billing
- Records management
- Critical thinking
- ICD-10 coding
- Balance reconciliation
- Multitasking and organization
- Clerical support
- Payer contracts
- Accounts receivable management
- Records maintenance
- Insurance claims
- Work prioritization
- Billing and collection procedures
- Commercial and private insurance
- Patient collections
Languages
Spanish, Professional Working
Timeline
Medical Billing Specialist
Texas Hearing Institute
06.2022 - Current
Medical and Dental Billing Specialist
Legacy Community Health
11.2018 - 02.2022
Patient Account Representative
Midwestern University Dental Institute
01.2014 - 09.2018
Patient Services Coordinator
Fort Bend Family Health Center
01.2011 - 01.2012
GED -
Morton College
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