Brenda Marie Espinoza
Edinburg
Summary
Expert in medical billing and coding with a strong track record in staff supervision and operational management. Skilled in implementing effective insurance verification strategies that enhance revenue cycle performance. Committed to fostering team development and maintaining compliance with coding standards to ensure optimal patient care.
Overview
20
20
years of professional experience
Work History
Supervisor
DHR Health
Edinburg
03.2025 - Current
- Supervised daily operations and staff performance within healthcare settings.
- Coordinated staff schedules and ensured adequate coverage for patient care.
- Monitored employee productivity to provide constructive feedback and coaching.
- Trained new employees on policies, procedures, and best practices in healthcare.
- Developed training materials to support ongoing employee development initiatives.
Insurance Verification Lead
Ambulatory Patient Access
09.2024 - 03.2025
- Consistently exceeding team goals for accurate and timely verification, training and mentoring new verification specialists to improve overall team performance
- Significantly reducing claim denials due to incorrect insurance information by implementing new verification procedures
- Resolved complex insurance coverage issues to minimize delays in claim processing
- Collaborated with billing teams to ensure accurate patient insurance data, enhancing revenue cycle efficiency
Insurance Verification Specialist
Ambulatory Patient Access
07.2024 - 09.2024
- Obtained necessary pre-authorizations by contacting insurance companies directly to ensure timely billing and reimbursement for healthcare providers.
- Verified patient insurance coverage, eligibility, and benefits for medical services to facilitate seamless access to healthcare.
- Verified patient insurance information for accuracy and completeness.
- Processed pre-authorization requests according to company protocols.
- Coordinated with healthcare providers to gather necessary documentation.
Insurance Verification
DHR Orthopedic Institute
07.2022 - 08.2024
- Called to obtain pre-authorization for recommended services and procedures, ensuring timely access to care for patients
- Verify insurance information for new and existing patients
- Update insurance information for existing patients
- Informed relevant clinical staff about denials, facilitating prompt resolution and minimizing service disruptions
- Explained patients' financial responsibilities, enhancing transparency and understanding of billing processes
- Answer questions related to billing and insurance
- Managed operations at RMF Clinics
Healthcare Specialist II Physician Analysis
Doctors Hospital Renaissance
03.2020 - 07.2022
- Tracked and managed release of medical records to insurance companies and law offices, facilitating timely access to necessary information
- Retrieves medical records by following chart-out procedures; documenting reasons charts cannot be retrieved for statistical and follow-up purposes
- Documented and communicated actions, irregularities, and ongoing needs to ensure continuity of work operations
- Maintains patient confidence by keeping patient records information confidential
- Adhered to professional standards, hospital policies, and regulatory requirements to safeguard hospital community and ensure compliance
- Sent deficiency letters to providers at 21, 30, and 42-day intervals to ensure timely follow-up.
- Concurrent report worked daily to make sure all procedures have been interfaced
- Assign deficiencies to providers when authenticating documents for each procedure that has been done
Risk Adjustment Coder
CSI Companies
01.2019 - 01.2020
- Verified accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered to improve coding integrity
- Review medical record information to identify all appropriate coding based on CMS HCC categories
- Assessed and documented claims and encounter coding information for Clinical Condition Categories
- Completed documentation and system entry for claims and encounters, ensuring compliance with coding standards
- Provided education and training on documentation quality, service levels, and diagnosis coding aligned with established guidelines
- Monitor Coding changes to ensure that the most current information is available
- Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information
Certified Medical Coder
Community Action Corporation of South Texas
01.2007 - 01.2019
- Coded, reviewed, and corrected progress notes to ensure accuracy and compliance
- Billed claims daily through electronic and paper methods for timely reimbursements
- Processed customer payments efficiently
- Worked the outstanding aging monthly reports
- Managed month-end accounting for E-clinical Works to maintain financial integrity
- Alice, TX
Billing Director
Laser Surgical Solutions
McAllen
01.2014 - 01.2017
- Coded and billed all hospital and clinic encounters
- Managed month-end accounting for E-clinical Works, ensuring accurate financial reporting.
- Completed daily bank deposits
- Coordinated provider credentialing with insurance companies to maintain compliance and streamline operations.
- Maintaining up-to-date CAQH information on all providers
- Oversaw renewal of Medicaid and Medicare contracts to ensure uninterrupted service delivery.
- Obtained NPI numbers for new providers to facilitate their enrollment in the practice.
- McAllen, TX
Education
Bachelor’s - Healthcare Management
The College of HealthCare Professions
01-2019
AAS - Health and Medical Administrative Services
The College of Healthcare Professions
05-2017
Certificate - Cybersecurity
DeVry University
Skills
- Insurance verification process
- Preauthorization and Referrals
- Patient claims management
- ICD-10 coding
- CPT Coding
- HCPCS coding compliance
- Procedure coding
- Medical Coding
- Medical Billing
- Electronic Health Records
- EClinicalWorks
- EMR Systems
- Medical Terminology
- Medical Records
- Compliance Monitoring
- Data management
- Practice management software
- Third-party insurance expertise
- Data management
Languages
Bilingual
Degree
B.S., CPC, CPPM
Personal Information
Authorized To Work: US for any employer
Timeline
Supervisor
DHR Health
03.2025 - Current
Insurance Verification Lead
Ambulatory Patient Access
09.2024 - 03.2025
Insurance Verification Specialist
Ambulatory Patient Access
07.2024 - 09.2024
Insurance Verification
DHR Orthopedic Institute
07.2022 - 08.2024
Healthcare Specialist II Physician Analysis
Doctors Hospital Renaissance
03.2020 - 07.2022
Risk Adjustment Coder
CSI Companies
01.2019 - 01.2020
Billing Director
Laser Surgical Solutions
01.2014 - 01.2017
Certified Medical Coder
Community Action Corporation of South Texas
01.2007 - 01.2019
Bachelor’s - Healthcare Management
The College of HealthCare Professions
AAS - Health and Medical Administrative Services
The College of Healthcare Professions
Certificate - Cybersecurity
DeVry University