Diana Valdez
Bronx
Summary
Dynamic and results-driven leader with over 10 years of experience in administrative healthcare, specializing in comprehensive support for complex medical groups and health clinics. Expertise in managing front-office operations, including customer service, patient appointments, billing and collections, and records management, while upholding the highest standards of confidentiality. Proven ability to streamline processes and enhance patient experiences through effective communication and organizational skills. Committed to fostering a collaborative environment that prioritizes patient care and operational excellence.
Overview
13
13
years of professional experience
Work History
Revenue Cycle Certified Coder / AR Denial Specialist
Columbia University
New York, NY
12.2021 - Current
- Investigated and documented reasons for claim denials from insurance companies to facilitate effective appeals.
- Acted as primary point of contact for third-party billing company to streamline operations.
- Conducted thorough evaluations of coding errors in claims to reduce outstanding accounts receivable.
- Collaborated with complex insurance payers to facilitate payment processes and uphold strong professional relationships.
- Coordinated outreach to payers and customers for payment requests and to develop tailored payment plans.
- Analyzed assigned accounts to establish appropriate actions for charge correction appeal adjustments based on EOB denial outcomes.
- Investigated and rectified complex coding denials, enhancing overall claims processing efficiency.
- Analyzed and rectified claims with incorrect modifier CPT codes or ICD-10 diagnosis codes to facilitate timely resubmission.
- Developed comprehensive letters of medical necessity that successfully addressed denied claims, aligning with payer requirements and enhancing approval rates.
- Managed the process of completing and submitting approved reconsideration requests and appeals to optimize insurance claim resolutions.
- Achieved timely updates of account statuses through meticulous documentation of follow-up activities in EMR. Maintained accurate records of promised payments, contributing to improved financial tracking.
- Evaluated accounts receivable data to determine required modifications and automated adjustments aimed at optimizing operational workflows.
- Monitored payer denial trends through detailed examination of CPT and ICD-10 codes, ensuring timely escalation to senior leadership for strategic decision-making.
- Engaged in professional development activities to maintain and expand job-related expertise.
- Engaged actively in a team-oriented work environment, promoting synergy and collective problem-solving efforts.
- Managed various tasks as designated, adhering to established scope of practice guidelines.
- Analyzed and coded medical records for accuracy and compliance with federal regulations.
- Collaborated with healthcare teams to clarify documentation and improve coding practices.
Administrative Aide
Columbia University
New York, NY
05.2019 - 06.2020
- Coded Inpatient/Outpatient Charts for Medical Assessments and Discharge Summaries
- ICD -9 coding, Data entry, Prepare statistical reports
- Close out discharged charts, Filing, Release of information
- Emailed providers every month with their Audit Reports and charge corrections
- Collected ECT notes every week from Milstein 9GN
- Researched Self-pay inpatient services on the Eagle System
- Prepared and made deposits of insurance and/or patient payments, Verified insurance eligibility
- Reviewed and extracted all CROWN encounters into GE/IDX
- Conformed to all applicable HIPAA, billing compliance, and safety guidelines
- Reviewed and resolved all first-level TES edits
Billing Compliance Lead
Columbia University
New York, NY
09.2013 - 07.2016
- Supervise daily billing compliance operations to ensure adherence to federal, state, and payer-specific regulations.
- Monitor and audit billing practices for accuracy, completeness, and compliance with CMS, Medicare, Medicaid, and commercial payer guidelines.
- Lead, train, and evaluate billing and compliance staff; provide ongoing coaching and performance feedback.
- Develop, implement, and maintain billing compliance policies, procedures, and internal controls.
- Conduct routine and targeted audits to identify trends, risks, and opportunities for improvement.
- Investigate billing discrepancies, denials, and compliance concerns; recommend and implement corrective action plans.
- Collaborate with coding, patient access, clinical, and revenue cycle teams to resolve compliance issues and improve billing accuracy.
- Ensure timely response to internal and external audits, payer inquiries, and regulatory reviews.
- Track, analyze, and report compliance metrics, audit findings, and corrective actions to leadership.
- Stay current on regulatory changes and educate staff on updated billing, coding, and compliance requirements.
- Support process improvement initiatives to reduce billing errors, minimize risk, and optimize revenue integrity.
- Utilize healthcare billing systems and EHR platforms (e.g., EPIC) to monitor compliance and reporting.
Education
MBA - Health Services and Risk Management
Metropolitan College of New York
New York, NY01-2021
BA - Healthcare Systems and Management
Metropolitan College of New York
New York, NY01-2019
CPC - Medical Billing and Coding
The Roxbury Institute for Medical Management
New York, NY01-2012
Skills
- Excellent oral and communications
- Strategic planning
- Great customer service
- Fluent in English/Proficient Spanish
- Excellent Interpersonal Skills
- Business management skills
- Analytical and problem-solving skills
- Critical thinking skills
- Team building & leadership
- Proficient Microsoft Suite
- Well versed in medical software’s
- EPIC, IDX, ENCODER PRO, CROWN, ECLIPSYS, CLINISOFT, EMR SYSTEMS, ECLIPSE, E-CLINICAL, WEBCIS, MEDISOFT, CENTRICITY
- Denial management strategies
Timeline
Revenue Cycle Certified Coder / AR Denial Specialist
Columbia University
12.2021 - Current
Administrative Aide
Columbia University
05.2019 - 06.2020
Billing Compliance Lead
Columbia University
09.2013 - 07.2016
BA - Healthcare Systems and Management
Metropolitan College of New York
CPC - Medical Billing and Coding
The Roxbury Institute for Medical Management
MBA - Health Services and Risk Management
Metropolitan College of New York