Crystal Diaz Rivera
San Antonio
Summary
Detail-oriented and accomplished medical coder and biller with over thirteen years of experience in billing, claims processing, and comprehensive medical office administration. Expertise in EMR systems, insurance verification, and claims submissions for multiple physicians simultaneously, alongside proficiency in ICD-10, CPT, HCPCS codes, and medical terminology. Strong advocate for organization and time management as essential components of success, committed to fostering a collaborative spirit within a dynamic, forward-thinking company. Eager to leverage extensive skills to drive efficiency and accuracy in a challenging role that promotes professional growth while contributing to team success and organizational advancement.
Overview
18
18
years of professional experience
Work History
Coding & Billing
Universal Physicians Management Services
San Antonio, TX
01.2015 - Current
- Ensured accurate input of patient demographics and insurance details to facilitate seamless healthcare operations.
- Ensured timely submission of clean claims to various insurance providers, including commercial, Medicare, Medicaid, VA/Tricare, and CHAMPVA, to facilitate reimbursement processes.
- Assisted in processing claim rejections and appeals. Supported teams in resolving discrepancies in claims. Facilitated communication between departments to address claim issues.
- Executed preparation of patient statements to enhance clarity and transparency in financial transactions.
- Achieved timely resolution of patient accounts through efficient write-off processing. Enhanced recovery efforts by preparing patient collections for appropriate agencies. Improved overall collections strategy by streamlining account management.
- Provided support to patients by clarifying account balance inquiries and ensuring accurate information delivery.
- Managed comprehensive scanning processes for all batches and pertinent documentation, ensuring systematic organization within the database.
- Regularly fulfilled established productivity and quality criteria, ensuring optimal performance outcomes.
- Achieved timely processing of medical claims, resulting in improved cash flow for the organization. Enhanced billing accuracy through effective collaboration with healthcare providers. Resolved discrepancies swiftly, contributing to overall operational efficiency.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Passionate about learning and committed to continual improvement.
- Used critical thinking to break down problems, evaluate solutions, and make decisions.
- Paid attention to detail while completing assignments.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Proved successful working within tight deadlines and a fast-paced environment.
- Developed and maintained courteous and effective working relationships.
Customer Service (Manager)/Bookkeeper
La Fiesta Supermarket
San Antonio, TX
11.2007 - 02.2019
- Oversaw daily operations of front-end team to enhance customer service experience. Trained and mentored staff to improve performance and efficiency. Implemented strategies to streamline checkout processes and reduce wait times.
- Achieved improved office efficiency through effective management of administrative tasks. Enhanced team productivity by organizing schedules and facilitating communication. Contributed to a positive work environment by supporting team members in daily operations.
- Oversaw team operations and strategic initiatives to enhance productivity.
- Achieved efficient document preparation and data management through proficient use of Microsoft Word and Excel. Enhanced team collaboration by facilitating training sessions on software functionalities. Improved overall productivity by implementing best practices in office software usage.
- Managed financial transactions and maintained organized records to support business operations.
- Achieved seamless communication by efficiently managing phone inquiries and resolving client issues. Streamlined document processing through effective fax management. Contributed to overall office efficiency by optimizing communication workflows.
- Oversaw Western Union transaction processes for utility payments and check cashing operations. Managed customer interactions to enhance service delivery and satisfaction. Developed strategies to streamline transaction workflows and improve efficiency.
- Assisted in processing cash transactions and managing money deposits. Supported daily cash reconciliation to maintain accurate financial records. Contributed to maintaining a secure cash handling environment.
- Developed and implemented operational strategies to streamline service processes, reducing wait times significantly.
- Resolved customer complaints while prioritizing customer satisfaction and loyalty.
- Oversaw daily operations of the customer service department, ensuring adherence to company policies and procedures effectively.
- Assisted with pricing questions, inventory availability and changes to existing order and shipping information.
- Facilitated clear communication between departments, ensuring seamless resolution of customer concerns in a timely manner.
Medical Biller and Coder
Tri-State Toxicology LLC/Tox Management LLC
San Antonio, TX
11.2013 - 01.2015
- Ensured timely submission of clean claims to insurance providers to facilitate efficient reimbursement.
- Achieved timely resolution of out of network claims submissions and appeals through proactive engagement with insurance companies. Improved client satisfaction by effectively managing claim disputes and ensuring clear communication throughout the process.
- Managed commercial claims processing to ensure timely resolution and compliance with company policies.
- Achieved timely processing of Medicare claims, resulting in enhanced cash flow for healthcare providers. Resolved complex claim issues, contributing to a notable reduction in processing errors. Improved claims processing efficiency through effective collaboration and process optimization.
- Managed comprehensive updates and organization of medical records, encompassing electronic health records and payer identification numbers.
- Assisted in resolving claim rejections to promote timely outcomes. Supported colleagues in pinpointing claim-related issues. Aided in refining claim handling processes for better efficiency.
- Coordinated efforts to enhance clearing house efficiency and accuracy.
- Reviewed and processed patient accounts to produce detailed monthly statements reflecting services rendered and outstanding balances.
- Managed posting of insurance and patient payments to ensure accurate financial records.
- Evaluated each insurance payment to ensure adherence to contractual discount agreements.
- Investigated and addressed payment discrepancies by communicating with insurance companies.
- Managed identification and billing processes for secondary and tertiary insurances.
- Oversaw collection and management of patient demographic data to enhance operational efficiency. Collaborated with clinical staff to ensure comprehensive patient profiles. Championed initiatives to streamline data entry processes for improved accuracy.
- Executed laboratory experiments to ensure accurate data collection and analysis.
Education
Medical Administation Cer - Medical Administration
Concorde, Career College
San Antonio, TX04.2013
High School Diploma - Basic Course of Studies
Northside ISD, Health Careers High School
San Antonio, TX05.2007
Skills
- Supportive interpersonal skills
- Collaborative teamwork
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Multitasking Abilities
- Computer skills
- Organizational skills
- Excellent communication
- Calm under pressure
- Skilled in daily entry of 100 medical claims
Training
- (Externship)
- Sage - Medicine
- Dr. Carmen Cawley
- Internal Medicine
- 4114 Pond Hill Road Suite 202 Shavano Park, TX 78231
- 210-510-2141
- February 2013 to April 2013
- Greeting Patients
- Checking Patients In and Out
- Answering Phones
- Scanning Patients Files into EMR
- Scheduling Patient Appointments
- Inputting Patient Demographics
- Verification of Patient Insurance
- Collections of Co-Payments
- Introduction of Billing and Coding for the Office
- Getting Labs ready for Phlebotomist
Timeline
Coding & Billing
Universal Physicians Management Services
01.2015 - Current
Medical Biller and Coder
Tri-State Toxicology LLC/Tox Management LLC
11.2013 - 01.2015
Customer Service (Manager)/Bookkeeper
La Fiesta Supermarket
11.2007 - 02.2019
High School Diploma - Basic Course of Studies
Northside ISD, Health Careers High School
Medical Administation Cer - Medical Administration
Concorde, Career College