Claudia Constantino
Harker Heights
Summary
Dynamic Medical Billing and Coding Specialist with proven expertise at Elms Creek Family And Urgent Care Clinic. Skilled in ICD-10 coding and exceptional customer service, I enhanced claim accuracy and reduced denials through effective training and collaboration. Recognized for problem-solving abilities, I fostered strong relationships with providers and improved revenue collection processes.
Overview
15
15
years of professional experience
Work History
Medical Billing and Coding Specialist
Elms Creek Family And Urgent Care Clinic
09.2015 - Current
- Analyzed patient data to ensure accurate coding for insurance claims and compliance with regulations.
- Developed and implemented coding policies to enhance accuracy and reduce claim denials.
- Trained new staff on coding guidelines, improving team efficiency and knowledge retention.
- Reviewed medical records for completeness, ensuring alignment with coding standards and documentation requirements.
- Collaborated with healthcare providers to clarify diagnoses and procedures for optimal coding accuracy.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Input data into computer programs and filing systems.
- Processed medical claims with attention to detail, ensuring compliance with regulatory standards.
- Resolved billing discrepancies through thorough investigation and effective communication with healthcare providers.
- Mentored junior staff on best practices for billing processes and compliance measures.
- Analyzed trends in denied claims to identify areas for process improvement and staff training needs.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Located errors and promptly refiled rejected claims.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Maintained strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
- Collected payments and applied to patient accounts.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Precisely evaluated and verified benefits and eligibility.
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Filed and updated patient information and medical records.
- Coordinated with other departments to address any discrepancies or concerns related to charge capture or data entry accuracy.
- Liaised between patients, insurance companies, and billing office.
- Efficiently processed refunds or adjustments for patients when necessary, ensuring accuracy and compliance with company policies.
- Participated in departmental meetings, sharing insights and ideas for improving overall medical billing efficiency and revenue generation.
- Printed and reviewed monthly patient aging report and solicited overdue payments.
- Prepared billing correspondence and maintained database to organize billing information.
- Collaborated closely with the clinical team to ensure proper documentation was obtained for accurate billing purposes.
- Educated colleagues on best practices in medical billing, providing ongoing training sessions as needed.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Prepared billing statements for patients and verified correct diagnostic coding.
Customer Service Representative
GC Services
03.2010 - 06.2014
- Assisted customers with Spanish-language inquiries in a timely and professional manner.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Managed high-volume inbound calls, effectively prioritizing issues to ensure swift resolution and minimize hold times for customers.
- Enhanced customer satisfaction by addressing and resolving complex inquiries in both English and Spanish languages.
- Gained customer trust by providing knowledgeable and accurate information in both English and Spanish.
- Provided language translation services for customer service inquiries.
- Communicated with management when customer issues escalated and worked to find resolutions.
- Maintained high levels of customer satisfaction through empathetic listening, timely problem resolution, and personalized attention.
- Identified and responded to customer requests and concerns through email, online chat, and phone for both English and Spanish speaking customers.
- Met all call quality standards and daily quotas for first-call resolution.
- Consistently maintained a professional demeanor under pressure during high-call volume periods or challenging customer interactions.
- Streamlined communication for non-English speaking customers, providing accurate translations of company policies and product information.
Education
Medical Billing And Coding
Vista College
Killeen, TX06-2015
High School Diploma -
Wasco High School
Wasco, CA06-1997
Skills
- Teamwork
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Multitasking
- Excellent communication
- Critical thinking
- Active listening
- Decision-making
- Team building
- Task prioritization
- ICD-10 coding
- Microsoft Excel
- Computer proficiency
- EMR systems
- Electronic health records
- Medical documentation
Languages
Spanish
Native or Bilingual
Timeline
Medical Billing and Coding Specialist
Elms Creek Family And Urgent Care Clinic
09.2015 - Current
Customer Service Representative
GC Services
03.2010 - 06.2014
Medical Billing And Coding
Vista College
High School Diploma -
Wasco High School
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