Erica Galvez
Manchester,CT
Summary
Revenue Cycle Specialist with experience managing end-to-end medical billing operations in ambulatory surgery settings. Skilled in insurance claims processing, denial resolution, EOB analysis, and accounts receivable follow-up. Experienced with Epic, payment posting, EFT processing, and coordinating with payers to ensure accurate reimbursement.
Overview
13
13
years of professional experience
Work History
Revenue Cycle Specialist
CTGI
Rocky Hill, CT
11.2022 - Current
- Independently manage revenue cycle and billing operations for the Bloomfield surgical center location.
- Perform medical coding and charge entry using CPT and ICD-10 guidelines to ensure accurate claim submission.
- Process insurance claims, analyze EOBs, and conduct accounts receivable follow-ups for unpaid or underpaid claims.
- Investigate and resolve claim denials, underpayments, and insurance discrepancies through payer communication and appeals.
- Communicate with insurance carriers to verify benefits, resolve claim issues, and ensure proper reimbursement.
- Manage patient billing inquiries and coordinate payment arrangements for self-pay balances.
- Perform collection activities and resolve outstanding patient account balances.
- Post EFT payments, denials, and zero-payment remittances while reconciling accounts for accuracy.
- Prepare and reconcile daily payment deposits and coordinate physical bank deposits for collected funds.
- Utilize Epic and Microsoft Excel to track payments, analyze accounts, and maintain billing accuracy.
Senior Physician Billing Associate
Boston's Children's Hospital
Westwood , MA
11.2021 - 07.2022
- Submitted insurance claims and appeals in accordance with payer regulations and billing guidelines.
- Reviewed EOBs and resolved claim discrepancies, denials, and unpaid balances.
- Reconciled claim runs and processed payer responses to ensure accurate reimbursement.
- Communicated with insurance carriers to resolve billing and claims processing issues.
Patient Accounts Representative
Beth Israel Deaconess-Needham
Needham, MA
02.2020 - 08.2020
- To assure timely billing and follow-up of all inpatient and outpatient accounts for the assigned payers.
- Follow-up includes correction and resubmission of rejections, analysis of denials, billing secondary payers, reviewing trial balance for aging accounts and making follow-up calls to 3rd parties to obtain status of claims.
- Responsible for working the account until, account balance becomes zero, including resolution and refunding of credit balances.
Patient Financial Services Representative
Steward Health Care
Westwood, MA
04.2017 - 06.2019
- Answers incoming patient calls totaling to 60+ calls a day
- Responsible for processing primary, secondary, and tertiary claims according to respective regulations and policies
- Interpret Explanation of Benefits (EOB) and maintains current knowledge of payer rules and regulations
- Receive and process patient credit card payments, and allocate to appropriate visits on the account
- Corresponds with third-party representatives, as necessary, to complete claims processing and/or resolve problem claims
- Reprocessed and adjusted all billing, collections, cash posting, and denial requests
- Completes and documents attorney requests for itemized billing.
- Assists patients with access to patient portal and password resets. Maintains strict confidentiality and adheres to all HIPAA guidelines/regulations.
- Monitor and resolve accounts daily on assigned Account Follow-up, Credit Balance, and Denial Work queues, along with Adjustment and Claim edit work queues.
Medical Coordinator
Signature Medical Group
Brockton, MA
02.2016 - 04.2017
- Documenting messages as required regarding illness, prescription refills, lab, radiology, imaging reports, test results, referrals, etc
- Making and editing appointments via computer for various departments
- Verifying data or entering changes to demographic and insurance screens. Familiarity with IDX, and Allscripts
Senior Member Services Representative
Harvard Pilgrim Health Care Inc.
Quincy, MA
07.2013 - 07.2015
- Handling high call volumes totaling to 60+ calls per day, while applying active listening skills in order to handle all customer interactions, courteously, and professionally
- Provided accurate and thorough information on benefits, eligibility, claims, and enrollment to members, prospective members, and internal customers while maintaining full compliance with all HIPPA regulations
- Interpreted Explanation of Benefits (EOB)
- Adjusted and reprocessed claims
Education
Bachelor of Science - Criminal Justice
Southern New Hampshire University
Hooksett, NH12-2026
High School Diploma -
Brockton High School
Brockton, MA2009
Skills
- Revenue Cycle Management
- Medical Billing & Coding (CPT / ICD-10)
- Insurance Claims Processing
- Denial Management & Appeals
- Accounts Receivable Follow-Up
- Patient Billing & Collections
- EOB Analysis
- Payment Posting & EFT Processing
- Healthcare Compliance & HIPAA
- Epic Electronic Health Records
- Microsoft Excel & Office
Timeline
Revenue Cycle Specialist
CTGI
11.2022 - Current
Senior Physician Billing Associate
Boston's Children's Hospital
11.2021 - 07.2022
Patient Accounts Representative
Beth Israel Deaconess-Needham
02.2020 - 08.2020
Patient Financial Services Representative
Steward Health Care
04.2017 - 06.2019
Medical Coordinator
Signature Medical Group
02.2016 - 04.2017
Senior Member Services Representative
Harvard Pilgrim Health Care Inc.
07.2013 - 07.2015
Bachelor of Science - Criminal Justice
Southern New Hampshire University
High School Diploma -
Brockton High School