CRYSTAL CRUZ
Yorktown Heights
Summary
I am passionate about using data to improve patient outcomes, streamline healthcare operations, and support evidence-based decisions. With a strong background in the medical field and a deep understanding of healthcare systems, I’m ready to take on the responsibilities of an Analyst. My goal is to drive meaningful change by identifying trends, reducing inefficiencies, and delivering insights that enhance patient care.
Overview
13
13
years of professional experience
Work History
Hospital Care Investigator - A/R Follow Up Unit Managed Medicaid
Lincoln Hospital
11.2022 - Current
- Ensure compliance with payer rules and regulations.
- Perform routine follow-up on outstanding insurance balances.
- Review and work appropriate accounts to maximize A/R reduction and minimize write-offs.
- Review payer denials and underpayments and work to resolution.
- Complete claims for review and processing by the Supervisor (Senior HCI).
- Interact with other departments to resolve outstanding payer balances.
- Refer accounts requiring escalation to Supervisor (Senior HCI) in a timely manner.
- Attend all necessary training sessions to effectively perform the day-to-day functions of the position.
- Perform all other duties, as assigned by the Patient Accounting Manager or Supervisor.
Hospital Care Investigator - Billing Unit
Lincoln Hospital
05.2022 - 11.2022
- Completing claim reviews and directed actions in a timely manner, for review and processing by the Senior.
- Effectively use computer systems.
- Document information clearly and completely in the financial systems.
- Ensure compliance with payer rules and regulations.
- Perform routine follow-up on outstanding insurance balances.
- Bill claims and resolve Claim Edits, Stop Bills and Discharge Not Billed claim edits.
- Review and work appropriate accounts to maximize accounts receivable reductions and minimize write-offs.
- Review claims and conducts actions and work claim to resolution.
Hospital Care Investigator- Patient Account Finance Dept.
Health and Hospital Corporation HHC- AT HOME
01.2012 - 03.2022
- Enters all pertinent insurance into EPIC systems and reviews all information prior to clearing for billing to insure accuracy and comprehensiveness.
- Completes full benefit investigation of patient’s primary and secondary insurance coverage to identify proper payor billing. Routinely re-verifies insurance when insurance coverage changes, or insurance claims are denied.
- Verifies insurance eligibility including but not limited to Medicaid, Medicare, Blue Cross, Commercial and all (HMO Insurance) Managed Care, No fault and worker comp
- Assist in supervising a unit engaged in medical assistance, investigation activities, assigning and controlling the flow of work, training and advising subordinates in difficult matters.
- Makes recommendations to improve and enhance our risk population in Surplus, Pool trust, 29day Medicaid upgrade, communications of the CHHAs with Insurance Verification Unit.
- Communicates and coordinates with Social Work Department to ascertain optimal patient Medicaid coverage.
- Provides the finance department with needed information to facilitate the billing and reimbursement process.
- Alerts agency billing personnel when there is a change in a patient's insurance and when authorization is received or denied.
- Attend all entitlement meetings of outside agencies that will assist in enhancing staff work performance.
- Troubleshooting such as, resolving all Medicaid denials, removing nursing home and ALP codes.
- Ensure proper billing procedures for Medicaid restricted recipients.
- Generate surplus bills and submit to the Medicaid Assistance Program.
- Conduct patient interview to ascertain eligibility for Medicaid.
- Assist patient with financial agreement to resolve remaining balance.
- Appeal decision whether it is for payment discrepancy or medical necessity.
- Reviews case records and/or recommendations for approval or denial and for appropriateness of category of assistance.
- Point person for emergency investigations, or investigations of a more difficult or complex nature.
Education
College Certification in Medical Billing & Coding -
SUNY Westchester Community College
New York, NY05.2025
College Certification in Cyber Security - undefined
SUNY Westchester Community College
New York, NY12.2024
High School Equivalency Diploma - undefined
01.2009
Skills
- Bilingual Spanish/ English
- 9 Years of Epic System
- Microsoft Office, Excel, Power point
- Unity Web Term, HHS Connect , Ability Medicare, Emdeon, Epaces
- All Hmo Insurances ,Working Comp, Surplus, New Medicaid App, Medicaid Upgrade, MSP App , Pool Trust, Managed Long Term Care
- Type 75 wmp, 10 years of Management, 15 years of Customer Service, Client Satisfaction
- Workflow management , Investergate research , Motivational interviewing , Recruitment/Staffing
Timeline
Hospital Care Investigator - A/R Follow Up Unit Managed Medicaid
Lincoln Hospital
11.2022 - Current
Hospital Care Investigator - Billing Unit
Lincoln Hospital
05.2022 - 11.2022
Hospital Care Investigator- Patient Account Finance Dept.
Health and Hospital Corporation HHC- AT HOME
01.2012 - 03.2022
College Certification in Cyber Security - undefined
SUNY Westchester Community College
High School Equivalency Diploma - undefined
College Certification in Medical Billing & Coding -
SUNY Westchester Community College
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