Cynthia Flores
Miami,FL
Summary
Dynamic and results-oriented Medical Billing Specialist with a proven track record at Continuum Global Solutions. Expert in HIPAA compliance and insurance billing, with exceptional skills in claims processing and customer service. Achieved significant improvements in billing accuracy and efficiency, demonstrating strong critical thinking and communication abilities.
Overview
15
15
years of professional experience
Work History
Pharmacy Medical Biller
Continuum Global Solutions
Los Angeles, CA
10.2021 - 07.2024
- Compiled and processed data for billing purposes utilizing billing software programs.
- Maintained up-to-date knowledge of government regulations related to healthcare reimbursement policies and procedures.
- Applied HIPAA privacy and security regulations while handling patient information.
- Processed claims for prescription medications through pharmacy and major medical channels.
- Conducted outbound calls to insurance companies to obtain patient benefit information when prescriptions were not covered.
- Initiated prior authorizations and managed documentation, including faxing requests for prior authorization and diagnosis codes, as well as requesting new prescriptions.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Submitted electronic claims accurately and efficiently.
- Maintained accurate patient data in electronic health records system.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Submitted claims to insurance companies.
- Communicated with insurance companies to verify eligibility and benefits via phone and chat.
Medical Collections Specialist
Kings bay pediatrics
Miami, FL
07.2017 - 03.2020
- Located and notified customers of delinquent accounts by mail, telephone, or personal visits to solicit payment.
- Performed data entry tasks related to patient account information updates.
- Documented all conversations between patients and staff related to collections activities.
- Negotiated credit extensions and waivers when necessary.
- Engaged with patients to address and manage their debt, ensuring timely payment resolutions.
- Answered customer questions regarding account discrepancies or problems.
- Uploaded documents through the electronic medical records system.
Medical Records Specialist
University of Miami Health System
Miami, Fl
06.2009 - 05.2017
- Maintained accurate documentation of all activities related to medical records.
- Coordinated with healthcare providers to clarify unclear or incomplete information in records.
- Reviewed medical records for completeness and accuracy, updating information as needed.
- Located and retrieved files, assisting public with general information.
- Adhered to HIPAA guidelines when handling protected health information.
- Assisted with chart preparation for upcoming appointments or surgeries.
- Supported administration staff with records requests to support patient care.
- Provided respectful assistance to patients, staff members and insurance company representatives.
- Processed requests for copies of patient medical files within designated timeframes.
- Managed release of information requests and identified requestors as patient, relation or provider.
- Kept department clean, organized and professional.
- Answered inquiries regarding the status of patient records or their availability.
- Pulled patient charts for upcoming appointments.
- Collaborated with multiple departments to coordinate release of information requests from patients, legal representatives, insurance companies.
- Monitored progress notes entered into the system by physicians or other healthcare providers.
- Reviewed medical records to ensure accuracy and completeness.
Education
High School Diploma -
American Academy
Miami06-1996
Skills
- Claims review
- Information requests
- Medicare and Medicaid process
- HIPAA compliance
- Submission of medical claims
- Collections management
- Verbal and written communication
- Insurance claims processing
- Medical terminology
- Insurance billing
- Medical billing
- Data entry
- Claims processing
- Insurance verification
- Critical thinking
- Customer service
- Patient billing
Languages
English
Professional
Spanish
Professional
Timeline
Pharmacy Medical Biller
Continuum Global Solutions
10.2021 - 07.2024
Medical Collections Specialist
Kings bay pediatrics
07.2017 - 03.2020
Medical Records Specialist
University of Miami Health System
06.2009 - 05.2017
High School Diploma -
American Academy
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