Daisy Rivera
Ocala
Summary
Resourceful and detail-oriented Billing and Collections, Clinical Payment Specialist, professional with 18+ years of Managed and monitored accounts receivable, ensuring timely collection of payments and reducing outstanding balances. Generated and distributed customer invoices, statements, and aging reports. Resolved customer billing discrepancies and inquiries, maintaining positive customer relationships. Accounts Payable. Processed and verified vendor invoices, ensuring accurate and timely payments. Resolving client-billing issues, and ensuring timely and accurate claims submissions. Proficient in medical billing, collections, and accounting software, with expertise in auditing, data entry, and customer service. Skilled in negotiating with insurance carriers and resolving complex billing discrepancies. Bilingual in Spanish.
Detail-oriented Collections Specialist with strong expertise in medical billing, negotiation, and customer service. Proven track record of resolving billing issues and enhancing accounts receivable performance.
Overview
25
25
years of professional experience
Work History
Collections Specialist
BMG Money
Biscayne Park
09.2020 - Current
- Making outbound collection calls in a professional manner to insurance carriers.
- Resolves client-billing problems and rescues accounts receivable delinquency.
- Provided customer service regarding collection.
Collections Specialist/ Clinical Payment Specialist
Reliabill Solutions
Delray Beach
06.2018 - 06.2020
- Making outbound collection calls in a professional manner to insurance carriers.
- Resolves client-billing problems and rescues accounts receivable delinquency.
- Manage the purchasing process within SAP at the affiliate level for clinical site contracts.
- Provided customer service regarding collections/billing issues.
- Rebilled rejected claims.
- Resolved client discrepancies and short pays.
- Monitored and maintained assigned accounts, customer calls, account adjustments, small balance write offs, customer reconciliations and processing credit memos.
- Appealing claims that are denied for medical necessity or for no authorization.
- Running a monthly report in Excel in of all the data information in which I need to collect.
Billing Specialist
The Haven Detox
West Palm Beach
08.2017 - 06.2020
- Responsible for adding new patients and payer data.
- Responsible for the claims that have rejected in the clearance house.
- Doing my own appeals and follow up after any claims or appeals that were sent.
- Obtaining billing data and census from clients and/or other departments.
- Submitting accurate claims in a timely manner.
- Review and troubleshoots errors.
- Auditing all claims billed on a daily basis.
- Reports all errors made/claims corrected on a daily basis.
- Making noted in the system pertaining to claims.
- Posting payments, verifying insurances, collections.
Billing Manager
Recovery Boot camp
Delray Beach
01.2017 - 06.2017
- Responsible for exporting reports to excel to have the employees work the AR.
- In charge of the incoming denials and appeals.
- EOB's Responsible in submitting accurate reports to the owner of the company to show what was being done with the accounts.
- I had to add all new patients and payer data.
- Obtaining billing data and census from clients and/or other departments.
- Submitting accurate claims in a timely manner.
- Review and troubleshoots errors.
- Auditing all claims billed on a daily basis.
- Reports all errors made/claims corrected on a daily basis.
- Making noted in the system pertaining to claims.
- Posting payments, verifying insurances, collections.
Billing Specialist
Infinity Behavioral Health Services Inc
Pembroke Pines
01.2015 - 12.2016
- Responsible for adding new patients and payer data.
- Obtaining billing data and census from clients and/or other departments.
- Submitting accurate claims in a timely manner.
- Review and troubleshoots errors.
- Auditing all claims billed on a daily basis.
- Reports all errors made/claims corrected on a daily basis.
- Making noted in the system pertaining to claims corrections, deletions and mailed/faxed claims.
- Responsible for all Workers Comp claims.
Grievances and Appeals Supervisor
MCNA
Wilton Manors
09.2011 - 12.2014
- Responsible for coordinating grievance appeals activity and ensuring compliance with state and federal regulations and accrediting bodies.
- Responsible for planning, organizing, and directing the work activity of the appeal and grievance team.
- Overseen researches, investigations, negotiations and resolution of all types of appeals and grievances.
- Responsible for reviewing correspondence from members requesting to file a grievance and/or appeal.
- Coordinated a response to the member in compliance with all specified timeframes.
- Responsible for coordinating the collection of all information and presentation to the Chief Dental Director and/or Appeals Committee.
- Assesses, investigates, and resolves difficult issues to achieve member satisfaction.
- Responsible for ensuring all timeframes throughout the grievance process are met.
- Researches member information in response to difficult inquiries, including, but not limited to, authorizations, payments, denials, coordination of benefits.
- Works closely with Dental Management to obtain clinical information for appeals for denial of services.
- Developed monthly reports on the grievance and appeal process including the number of appeals by category, number of denials upheld, and timeframe met.
- Assist Grievances and Appeals Director with reports.
- Assist with creating the departmental training manual, policies and procedures.
- Responsible for assisting grievances and Appeals Director with RFP's (Request for Proposal).
- Responsible for participating in all Readiness Review set for by the requested states.
Billing Supervisor
Holy Cross Medical Group
Sunrise
01.2009 - 08.2011
- Processing transactions on customer accounts, ensuring account is set up correctly, problem resolution, and auditing transaction activity.
- Communicating with customers and third-party contacts (i.e. banks and insurance companies) to ensure timely and accurate processing of account transactions.
- Performing and documenting quality assurance reviews on transactions.
- Analyzing and researching out-of-state insurance programs for claim and enrollment information to facilitate account transactions.
- Trending provider activity and claim denials.
Claims Variance Associate
Baptist Health South Florida
Miami
01.2001 - 12.2008
- Processing transactions on customer accounts, ensuring account is set up correctly, problem resolution, and auditing transaction activity.
- Communicating with customers and third-party contacts (i.e. banks and insurance companies) to ensure timely and accurate processing of account transactions.
- Performing and documenting quality assurance reviews on transactions.
- Analyzing and researching out-of-state insurance programs for claim and enrollment information to facilitate account transactions.
- Trending provider activity and claim denials.
Education
Online course in Claims Adjuter -
Miami Dade College
Miami, FLSkills
- Medical billing collections
- Medical Collection
- Accounts Receivable
- Microsoft Word
- QuickBooks
- Bank Reconciliation
- Data Entry
- Microsoft Excel
- Payroll
- Microsoft Office
- Medical Billing
- Workers' Compensation
- Microsoft Outlook
- Negotiation
- Accounts Payable
- Auditing
- Spanish
- General Ledger Reconciliation
- Computer skills
- Office Management
- Account Reconciliation
- ICD-10
References
- Leilani Rivera, 207-991-4313, Manager for BMG money, luvmenow19@gmail.com
- Michael Cox, 352-844-7126, Director for BMG money, Mgc912@gmail.com
- Veronica Diaz, 561-932-2332, Supervisor at Reliable Solution's, daisyrcftc.orl@gmail.com
Languages
- Spanish, Fluent
- English, Fluent
Personal Information
- Willing To Relocate: Anywhere
- Authorized To Work: US for any employer
Timeline
Collections Specialist
BMG Money
09.2020 - Current
Collections Specialist/ Clinical Payment Specialist
Reliabill Solutions
06.2018 - 06.2020
Billing Specialist
The Haven Detox
08.2017 - 06.2020
Billing Manager
Recovery Boot camp
01.2017 - 06.2017
Billing Specialist
Infinity Behavioral Health Services Inc
01.2015 - 12.2016
Grievances and Appeals Supervisor
MCNA
09.2011 - 12.2014
Billing Supervisor
Holy Cross Medical Group
01.2009 - 08.2011
Claims Variance Associate
Baptist Health South Florida
01.2001 - 12.2008
Online course in Claims Adjuter -
Miami Dade College