Blanca E. Contreras
Mesquite,USA
Summary
Bilingual communication and healthcare billing specialist with a strong track record in authorization management and credentialing compliance, driving significant improvements in billing efficiency at Mesa View Medical. Expertise in rural healthcare billing and medical terminology complements a proactive approach to training and process enhancement, demonstrating leadership and innovation in diverse environments.
Overview
18
18
years of professional experience
Work History
Lead Biller/Coder
Mesa View Medical
Mesquite, NV
09.2021 - 01.2025
- Handling a wide variety of medical claims including; Orthopedic, General Surgery, Cardiology, Wound Care and Hospitalist billing
- Workers compensation billing, obtaining authorization
- Coordinate scheduling, authorizations for procedures/surgeries/referrals with patients
- VA primary care authorization
- Reviewing specialty VA RFS request to make sure proper documentation is faxed for approval
- Working with upper management to assist with provider credentialing
- Reviewing provider's CAQH every 120 days to make sure all documents are updated
- Training staff regarding Medicare rules for RHC clinics
- Reviewing RHC billing to make sure the claim is properly correct
- Work RHC, non-RHC, surgeries, procedures denied claims
- Appealing claims via insurance portal, or on denied claims
- Training staff employees regarding health insurances, how to review health insurances via insurance portal
- Training billing staff how review claims before creating a claim
- Work weekly Collecting report/setting up payment plans for patients
- Attend weekly meetings with our corporation
Biller/Coder
Sequoia Urology
Porterville, CA
09.2022 - 10.2023
- Handling a wide variety of medical claims including; surgeries, office procedures, hospital consultations
- Working credentialing for provider
- Reviewing provider CAQH that it has been updated every 120 days
- Training staff regarding health insurance and how to review health insurances via insurance portal
- Training staff to understand the Athena One system and how to understand patient statements
- Appealing denied claims
- Work weekly Collecting report/setting up payment plans for patients
- Translating for Spanish speaking patients
- Attend weekly/monthly meetings
Biller
Red Sands Vein
St George, UT
07.2018 - 09.2019
- Creating/reviewing claims to make sure authorization was obtained, correct CPT/ICD-10 was entered, reviewing medical notes
- Work weekly Collecting report/setting up payment plans for patients
- Assisting with staff for patient cost of procedures, collecting patient prior to procedure
- Translating for Spanish speaking patients
Medicare Biller
Intermountain Healthcare
St George, UT
04.2016 - 05.2018
- Reviewing claims before creating to bill Medicare with correct patient information, i.e
- Medicare ID number, name, insurance coverage
- Following up on claims that have been billed to Medicare, verifying within Medicare System that claim was received and being processed
- Reviewing Medicare claims weekly/quarterly, looking over account(s) if corrected claims were received and being processed
- Billing Auto/TPL, Workers Comp claims, making sure that patient has opened a file with Medicare
- Reviewing / Billing consolidated billing, calling Hospice, Skilled Nursing facilities, and Home Health facilities to verify who they are billing, and analyzing charges to determine if charges need to be billed to facilities or to Medicare directly
- Attending bi-weekly Medicare training meetings
- Translating for Spanish speaking patients
Biller/Coder
Mesa View Medical
Mesquite, NV
08.2009 - 04.2016
- Handling a wide variety of medical claims including; surgeries, sleep studies, Orthopedic General Surgery, Pediatric, wound care and hospitalist
- Reviewing/Creating claims for workers compensation patients, obtain authorization
- Coordinate patients scheduling, obtaining authorizations for procedures, surgeries, or referrals
- Appealing denied claims
- Coordinating and scheduling sleep studies patients
- Coordinating Auto/TPL accident authorizations for care and follow up appointments
- Collecting patient balances or setting up payment plans for patients
- Working weekly collection/self-pay reports
- Translating for Spanish speaking patients
- Attend weekly/ monthly meetings with corporation
Receptionist/Biller
Mesquite Urology
Mesquite, NV
05.2007 - 10.2010
- Handled a wide variety of medical claims including; surgeries, in office procedures, and hospital consultations
- Entering all insurance claim payments
- Reviewed patients note before creating claim; i.e
- CPT, ICD-9, modifiers and HCPCS codes
- Scheduling patients, collecting co-pays, outstanding balances, and verifying eligibility/coverage
- Appealing denied claims
- Working weekly collection/self-pay reports
- Translating for Spanish speaking patients
- Attend weekly/ monthly meetings
Education
Medical Billing/Coding -
Las Vegas College
Las Vegas, Nevada01.2023
Medical Biller Cert. -
Medical Association of Biller
Las Vegas, Nevada01.2009
General Education -
Virgin Valley High School
Mesquite, Nevada06.1992
Skills
- Bilingual Communication: English/Spanish
- Healthcare Billing Specialist
- Authorization Management
- Rural Healthcare Billing Expertise
- Essential Medical Terminology Knowledge
- Fundamental ICD-10 Understanding
- Fundamental HCPCS Understanding
- Credentialing Compliance Oversight
Timeline
Biller/Coder
Sequoia Urology
09.2022 - 10.2023
Lead Biller/Coder
Mesa View Medical
09.2021 - 01.2025
Biller
Red Sands Vein
07.2018 - 09.2019
Medicare Biller
Intermountain Healthcare
04.2016 - 05.2018
Biller/Coder
Mesa View Medical
08.2009 - 04.2016
Receptionist/Biller
Mesquite Urology
05.2007 - 10.2010
Medical Billing/Coding -
Las Vegas College
Medical Biller Cert. -
Medical Association of Biller
General Education -
Virgin Valley High School
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