Summary
Overview
Work History
Education
Skills
Systems Experience
Accomplishments
Languages
Timeline
BusinessDevelopmentManager
Carlos Herrera

Carlos Herrera

Elizabeth,NJ

Summary

Experienced in billing and management with a strong background in accounts resolutions and follow-up. Valuable asset for any revenue cycle and accounts resolution needs. Proven ability to resolve issues and increase revenue, consistently delivering results. Thrives in a team environment, recognizing the importance of collaboration and knowledge sharing for the benefit of both the team and the company.

Overview

9
9
years of professional experience

Work History

Accounts Receivable Manager

Med-Metrix
06.2022 - 11.2024
  • Currently over see a team of 66 AR follow up representatives for both onshore and offshore
  • Oversee 2 supervisors and 1 offshore Manager to make sure that the daily tasks are completed accurately and timely
  • Tasks include: Attendance, Daily productivity of each rep, Weekly audits on accounts worked for accuracy and any trends found, Team huddles and minutes
  • Run daily reports that are used for statistical reasons: AR Collections Report, AR Resolution, Inventory reports, Cash posted
  • Work specific accounts for follow up and resolutions by checking claim status thru payer portal or making phone call
  • Oversee the credit balance accounts for accuracy
  • Determine if the credit is an insurance over payment or over posted adjustment/contractual amount
  • Audit accounts worked by team for productivity and accuracy to ensure that follow up process was implemented
  • Create processes and train the team in any new processes for completing and proper follow-up
  • Report KPI information to the VP with statistics from weekly reports that includes: Inventory Accounts, Accounts worked, Number of team members per week, Resolved Accounts, Cash Posted on a weekly basis, Placement of Accounts
  • Handled AR amount of $45M of open balances to reduce for accounts 90 days and older
  • Oversee and gather information for monthly Slide Deck presentation to our client for their Inventory and Revenue information
  • Provide back up to Director on presentation as presenter
  • Weekly meetings with the client regarding issues that need attention and provide feedback on contractual issues and proper handling of inventory placements that need to be sent back to the client
  • Processes put into place and trends identified that will hinder the claims to be finalized by the payer
  • Create ticket requests to our data and customer service team when new actions/statuses are needed into our integrated billing system and follow up on these tickets till they are completed and closed
  • Update our OneNote that provides all supporting tools and procedures that are used by the team
  • Daily meeting with onshore and offshore team for matters that need attention for the day and/or week
  • Responsible for creating accounts and credentials for all insurance portals that the team needs
  • Report weekly and monthly QA stats for each team member to my Director and Vice President
  • Handle disciplinary actions to anyone in the team after proper steps are followed

Revenue Cycle Manager

Sierra Health Group Associates
06.2019 - 06.2022
  • Oversee a team of 11 billing and follow up representatives onshore and a team of 10 representatives offshore
  • Create and report on a daily productivity report for each staff on completed accounts
  • Audit on completed claims for proper follow up and any corrections needed for future training
  • Run a daily AR open balance report for statistical usage
  • This will show me what denial reasons are outstanding and a total number of claims for each claim status that needs attention
  • On the daily AR open balance report, cut out specific claims that needs to be distributed to the team for immediate follow up
  • Create a report that determines the estimated amount of time of each claim to be completed with the amount of claims that should be completed on daily basis and an estimated timeframe for the report/claims to be completed by each staff member
  • Provide statistical figures for denied claims to the owners of the company
  • This information is then provided to the client
  • Provide feedback and submit requests on Physician Credentials denials
  • Contact the credentialing team to review and update on their licenses
  • Contact the coding unit for CPT/DX code issues that need to be addressed, or any updates needed for billing purposes
  • Maintain several reports that is provided to higher management for statistical reasons
  • Contact payers for additional information needed or when a staff is not able to obtain the information needed to be able to correct a claim and resubmit for additional payment
  • Review and approve adjustments needed due to contractual payments
  • Also post adjustments as needed
  • Follow up on all reports that have been distributed for completion on the timeframe given
  • Created policy and procedures on any tasks that need to be corrected and/or any new trends that have been discovered

Billing Manager

Cerebral Palsy of North Jersey
02.2017 - 06.2019
  • Daily meeting with CFO on revenue issues and updates on process
  • Daily reports on failed claims to correct and resubmit to insurance for processing and payment
  • Run a weekly aging report for all Medicaid and private pay outstanding balances for follow up
  • Run a monthly report on all posted payment received and opened outstanding balances
  • Provide the monthly report to the finance department to be able to close the month
  • Manage a team of 2 billers and provide support where is needed for billing
  • Work closely with the NJ Medicaid provider enrollment for verification and any updates needed for registering any new sites to be able to bill NJ Medicaid
  • Complete any applications needed for the State of NJ for billing purposes
  • Work closely with the IT department on current revamp on the billing system currently being used which is Carelogic and revenue software Fund EZ
  • Provide help to the finance department for any insurance payment posting matters
  • Submit electronic billing file to Molina Medicaid Solutions for processing and payment
  • Submit and approve any write-off request due to timely filing and/or incorrect billing done
  • Run an open AR aging report to distribute to the team for claims that need attention and follow up
  • Post payments to open claims for all Self-Pay clients
  • Approve all claims that are ready to be submitted electronically for billing
  • Create an electronic EDI file and transmit to Molina Medicaid for processing and payment
  • Run a Service History Billed Report once EDI file has been submitted and distribute report to each Program Director to verify with the client’s schedule
  • Complete all proper provider enrollment applications that is needed to be submitted to Division of Developmental Disability
  • Work with the Systems Administrator an IT Director on any changes or corrections needed on the Carelogic billing system

Account Specialist

Children’s Specialized Hospital
03.2016 - 01.2017
  • Manage the NJ Medicaid Aged Revenue Accounts for outstanding unpaid hospital claims
  • Contact insurance to get status on previously submitted or denied claims
  • Resubmit claims that are not on file or claims that needed corrections to be reprocessed for payment
  • Submit appeals to NJ Medicaid with proper supporting documentation for claims reconsideration
  • Maintain accurate patient demographics in order for proper billing to be done to insurance
  • Update any discrepancies to management regarding claims that need further review

Education

Associates - Computer Information Systems

Union County College
Cranford, NJ
06.2019

Skills

  • Microsoft Office
  • Excel Vlookup
  • Pivot tables
  • Filtering and summarizing data
  • Superior ability to achieve immediate and long-term goals
  • Ability to execute a number of projects within a timely manner
  • Excellent interpersonal communication skills
  • Work well under pressure
  • Fluent in Spanish
  • ECW
  • EPIC
  • MPower
  • MediTech

Systems Experience

  • ECW
  • EPIC
  • MPower
  • MediTech

Accomplishments

Great success in revenue intake and decrease of AR from time that project started. Ability to analyze trends that have helped in the decrease of the AR and having claims reprocessed and paid for a positive turnaround.

Accomplished getting my associates degree in Computer Information Systems.

Languages

Spanish
Native or Bilingual
English
Native or Bilingual

Timeline

Accounts Receivable Manager

Med-Metrix
06.2022 - 11.2024

Revenue Cycle Manager

Sierra Health Group Associates
06.2019 - 06.2022

Billing Manager

Cerebral Palsy of North Jersey
02.2017 - 06.2019

Account Specialist

Children’s Specialized Hospital
03.2016 - 01.2017

Associates - Computer Information Systems

Union County College

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Carlos Herrera