Esmeralda Espinoza
Suncoast Surgical Associates, PA
Seffner,FL
2
Languages
10
years of professional experience
Detail-oriented Medical Billing Specialist with experience in accounts receivable, insurance follow-up, patient collections, and Independent Dispute Resolution (IDR). Skilled at managing multiple priorities with accuracy in fast-paced healthcare environments.
Work History
Billing Specialist
2 Years 4 Months- Coordinated with insurance companies to resolve billing discrepancies efficiently.
- Processed patient billing claims with accuracy and attention to detail.
- Reviewed and updated patient accounts to ensure current information and compliance.
- Manage federal Independent Dispute Resolution (IDR) cases under the No Surprises Act from submission through final determination.
- Prepare, submit, and track IDR payment offers while ensuring compliance with federal deadlines.
- Research disputes and compile supporting documentation for arbitration cases.
- File CMS complaints for unresolved or non-compliant IDR cases.
- Communicate with IDR entities regarding pending disputes, payment issues, and case updates.
- Challenge incorrect IDR closures and inaccurate determinations by submitting formal objections.
- Analyze payer discrepancies and resolve claim denials, underpayments, and payment variances.
- Submit corrected claims and resubmissions to commercial and government insurance carriers.
- Collect patient financial responsibility, including copays, deductibles, and coinsurance, and coordinate collection activities for delinquent accounts.
Accounts Receivable Representative
8 Months- Streamlined billing processes, enhancing accuracy and minimizing errors.
- Maintained strong client relationships through clear communication and timely resolution of disputes.
- Communicated with customers to resolve outstanding payments, ensuring timely collections.
- Mitigated risk by conducting thorough credit checks on new customers.
- Contacted auto and health insurance companies to dispute duplicate denial claims.
- Managed mail operations by sorting and depositing checks, ensuring accurate record-keeping for each facility.
- Recorded deposits, reconciled monthly bank accounts.
Attorney Liaison
8 Months- Answered high-volume calls from attorneys regarding status of medical records, reduction requests, updated invoices, and client auto insurance payments.
- Processed reduction requests from attorneys via fax and email, agreeing to or counteroffering the proposed amounts.
- Received requests via email and fax from attorneys requesting updated invoices for their client's account.
- Ensured timely resubmission of claims to facilitate payments. to auto insurances if claim was not received.
- Contacted PIP adjusters for payment status on patient accounts to ensure timely resolution.
Medical Records Coordinator
5 Months- Processed medical records requests from outside providers in compliance with facility, state, and federal regulations.
- Kept accurate log of requests for medical information and records.
- Maintained accuracy, completeness, and security for medical records and health information.
- Secured necessary signatures on information release forms to facilitate acquisition of medical and treatment records from other service providers.
- Managed sensitive patient information securely while responding promptly to authorized requests for access or copies of records.
- Maintained strict adherence to HIPAA regulations, safeguarding patient confidentiality and privacy.
Front Desk Receptionist/Scheduling Coordinator
8 Months- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
- Scheduled, coordinated and confirmed appointments and advising patient's of their patient responsibility at the time of service.
- Delivered outstanding first impressions by warmly greeting visitors upon arrival at the front desk.
- Called patient's to make them aware if their insurance denied their exam, offered them self-pay.
- Expedited check-in and check-out procedures for guests, ensuring seamless experiences during their visits.
Manager
3 Years 10 Months- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Cross-trained existing employees to maximize team agility and performance.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
Crew Member
2 Years 3 Months- Worked front counter, drive-thru and other areas.
- Took orders, prepared meals, and collected payments.
- Demonstrated strong multitasking abilities, handling multiple orders simultaneously without compromising quality or efficiency.
- Worked well with teammates and accepted coaching from management team.
- Collaborated with team members to complete orders.
- Improved customer satisfaction by providing friendly and efficient service at the register.
- Provided excellent customer service by greeting customers and meeting quality expectations.
Education
High School Diploma
- 5.4 GPA
Skills
Verbal Communication
Payment Negotiations
Financial records and reporting
Information gathering and analysis
Time Management
Insurance verification
Customer service
Critical Thinking
Ability to work great under pressure
Ability to multi-task
Medical Billing
Accounts Receivable
Independent Dispute Resolution (IDR)
No Surprises Act Compliance
CMS Complaint Submission
Denial Management
Insurance Claims Processing
Corrected Claims
Payment Posting
Patient Collections
Languages
Spanish
Full Professional
English
Native or Bilingual
Timeline
Billing Specialist
Suncoast Surgical Associates, PA
04.2024 - CurrentRead More
Accounts Receivable Representative
MRI Associates Of Palm Harbor, LLC
08.2023 - 04.2024Read More
Attorney Liaison
MRI Associates Of Palm Harbor, LLC
01.2023 - 09.2023Read More
Medical Records Coordinator
MRI Associates Of Palm Harbor, LLC
08.2022 - 01.2023Read More
Front Desk Receptionist/Scheduling Coordinator
MRI Associates Of Brandon, LLC
12.2021 - 08.2022Read More
Manager
McDonald's
08.2018 - 06.2022Read More
Crew Member
McDonald's
05.2016 - 08.2018Read More
Armwood High School
High School Diploma
Read More