Diana Rodriguez
Maxwell,TX
Summary
Responsible AR Biller Coordinator/Financial Counselor with excellent communication skills demonstrated by over 20 years of experience. Familiar with commercial, government payers and private pay health insurance carriers as well as knowledge of CPT and ICD-9. Familiar with HCPA, Texas Department of Insurance regulations regarding health insurance appeals and grievances. Familiar with CMS regulations regarding appeals/grievances.
Overview
21
21
years of professional experience
Work History
AR BILLER FOR REFUND AND UNPOSTABLES
- Investigated and analyze spreadsheets of unapplied balances to resolution
- Processed refund requests from patients/insurance companies and staff in a timely manner, meeting all deadlines
- Responsible for completing monthly written progress reports to Supervisor
- Processed account receivable write-off, reversals, reallocations of complex transactions
- Sorted, processed and audited all appropriate paperwork for insurance, government, patient and Non-A/R refunds including researching and corresponding on missing payments, misdirected and unidentified payments, returned refunds and maintaining accounts
- Assisted with internal audits and refunds, which comply with quality controls, checks and balances in accordance with departmental policies, procedures, and all applicable laws and regulations
- Interpret and resolve written and phone correspondence involving credit balances, transfers of insurance, client or patient payments and/or information.
Payment Poster
Seton Healthcare/Revenue Cycle One/AMG
- Daily processing and posting of patient and insurance payments
- Accurately posts payments and adjustments according to current standards of contracts set
- Applied patient payments by determined method of payment
- Answered patient and insurance company phone calls
- Reversals of payments, adjustments and refunds
- Worked and clears any unapplied credit reports or money by researched and analyzed reimbursements.
AR BILLER COLLECTION COORDINATOR
Revenue Cycle One Mgmt./AMG
Austin, TX
10.2015 - 04.2022
- Maintained all documentation associated with the processing and handling of appeals to comply with regulatory standards and periods while maintaining an accurate, complete appeals record in the electronic database
- Coordinated / validated claims transmitted to ensure edit criteria was met and took appropriate action to follow up
- Performed audits on account and developed quality improvements to meet the need of the provider/filed written appeals/documented action taken on appeals
- Performed detailed A/R research and solved problems related to unapplied cash receipts and refunds
- Researched, analyzed and reconciled commercial and government payers Interacted with other departments including Customer Service, Claims and Provider Relations to resolve member and provider appeals
- Conducted appeals research and filing including, but not limited to, requesting waivers of liability and/or appointment of representative forms, organizational determination research, requesting member medical records, organizing documentation, preparing written summaries, scheduling the case, processing the review of case, documentation of the appeal resolution and sending completed case files to external review organizations as required by regulatory guideline
- Prepared, verified and transmitted patient/insurance claims in the appropriate format according to guidelines
- Worked AR report beginning >120 aging top dollar working in descending order/resolved accounts in a timely manner
Patient Financial Counselor
Seton Healthcare/Revenue Cycle One Mgmt./AMG
01.2001 - 10.2015
- Counseled patients regarding insurance benefits and recommend alternative sources of payment and financial assistance when appropriate.
- Contacted insurance carriers or other sources and act as an advocate for the patient.
- Initiated process for collecting prepays due and perform follow up activity to ensure maximum collection is achieved.
- Identified hospital, public and private financial assistance programs for patients unable to meet their financial obligations.
- Provided assistance to uninsured patients and families in completing and filing Medicaid or assistance program applications with the appropriate agency.
- Educated patients on their responsibility and potential options/explanation of benefits Explained to the patient their financial obligations during the financial counseling session.
- Provided assistance to uninsured patients and families in completing and filing Medicaid or assistance program applications with the appropriate agency.
Education
Certified Billing and Coding Specialist -
National Healthcare Association
01.2021
Skills
- Excellent Communication
- Decision Maker
- Self-motivator
- Bilingual
- Payment Tracking
- Insurance Billing Procedure
Languages
Spanish
Professional
Timeline
AR BILLER COLLECTION COORDINATOR
Revenue Cycle One Mgmt./AMG
10.2015 - 04.2022
Patient Financial Counselor
Seton Healthcare/Revenue Cycle One Mgmt./AMG
01.2001 - 10.2015
Certified Billing and Coding Specialist -
National Healthcare Association
AR BILLER FOR REFUND AND UNPOSTABLES
Payment Poster
Seton Healthcare/Revenue Cycle One/AMG