Estella Garcia
San Antonio
Summary
Results-driven professional with a strong background in HIPAA and OSHA compliance, medical terminology, and coding. Successfully coordinated revenue cycle initiatives, achieving significant improvements in operational efficiency and client satisfaction.
Overview
19
19
years of professional experience
Work History
Director, Payor Management
Quick Med Claims
01.2021 - Current
- Company Overview: An EMS Billing service for both air and ground transportation who provides revenue cycle support in 45 states within the US.
- My team was responsible for new Medicare (PECOS) and Medicaid applications for our clients brand new to billing.
- We also assisted clients with completing their revalidations and any other updates needed for the government payors including change of information (COI), Board of Director updates and any demographic updates.
- Contracting and credentialing functions for all commercial payors.
- Clearinghouse enrollments (Claim, ERA, EFT and RTE) done through multiple clearinghouse vendors including Change Healthcare, TriZetto and Waystar.
- Our provider volume was 400+ EMS providers that we supported for any clearinghouse, demographic update and/or new credentialing applications.
- An EMS Billing service for both air and ground transportation who provides revenue cycle support in 45 states within the US.
Director, Patient Accounts
Pinnacle Dermatology
Lombard
01.2019 - 01.2020
- Provide oversight to all revenue cycle process improvement initiatives to ensure timely completion and desired outcomes are achieved.
- Coordinate and implement strategies that enhances revenue cycle operations which included documenting workflows for each role within the department and created all training documents for new hires.
- Perform financial analysis to identify opportunities for cost savings and/or net revenue improvements.
Insurance Follow-Up Manager
Boncura Health Solutions
Downers Grove
01.2014 - 01.2019
- Responsible for the account receivable of 7 different clients totaling $162 million in charges each month including credentialing, denial management and third party follow up on HCFA 1500 and UB claims.
- Handle financial analysis and reporting of billing revenue cycle and practice operations.
- Monitored revenue progress against benchmark front end metrics and accounts receivables targets, and the resolved actual-to-budget variances.
- Implement and monitor new client acquisitions and work down the legacy A/R which could be in various billing practice management systems.
- Responsible for managing the insurance follow up team, consisting of 60+ employees.
- Served as a Liaison for employees on all Human Resources related topics and situations including but not limited to screen/conduct interviews, maintain all requisitions for the department, create/update job descriptions for each role within the department, send welcome letters to all new hires, create training schedules and ensure all system and key badges access was obtained prior to first day.
- Complete all Onboarding/Offboarding through various portals including ADP, Ulti-pro, etc. as well as approve timecards, track attendance, FMLA and occurrences as well as present disciplinary action/corrective action plans.
- Set up reward and incentive programs for the department as well as conducted annual performance reviews and distributed merit increases based on yearly performances.
- Workers’ Compensation case management for patients and employees.
- Extensive knowledge of Insurance and Benefits for Government plans such as Medicare, Medicare Advantage and HFS and all other major insurance carriers such as BCBS, Humana, Aetna, UHC and miscellaneous commercial plans.
- Perform monthly employee audits measuring procedural and accuracy on a scorecard, while providing feedback and support as needed.
- Demonstrated willingness and ability to work collaboratively with key internal staff to address high level issues.
- Meet with clients monthly to present reporting package to discuss performance and new trends to identify opportunities for improvements.
- Meet with insurance company representatives to get educated on new updates, review monthly newsletter and to discuss escalated issues and possible resolution.
EDI Processor
Boncura Health Solutions
Downers Grove
01.2010 - 01.2014
- Responsible for the analysis and support of payer and work with IT to upgrade provider master files.
- System testing related to upgrades and enhancements across all Patient Account Operations including registration, payment posting, insurance follow up and/or self-pay collections.
- Generate collection self-pay letters and statements and upload to the vendor portal.
- Create claim files daily and transmit/reconcile through clearinghouse vendor (RealMed, Nebo/Passport, etc.).
- Complete all provider/payer enrollment forms for EDI, Eligibility, EFT and/or ERA.
- Resolve front end claim rejection errors daily to ensure clean claims were submitted to the payers within the Epic practice management system.
Medical Assistant/Referral Coordinator
Fox Valley Women & Children’s Health Partners
St. Charles
01.2007 - 01.2009
- Responsible for ensuring that all phases of the patient’s visit were complete in an accurate and timely manner to guarantee proper patient care.
- Room patient’s, take vitals, chart in EMR (Greenway), administer vaccines, performs simple lab testing (i.e., UA’s, Rapid Strep/Mono, hgb etc.).
- Additional responsibilities include some clerical items such as preparing charts, patient education material, processing HMO referrals and scheduling patient appointments.
Education
Certified Medical Assistant -
Everest College
Aurora, IL01-2007
Skills
- Leadership training
- HIPAA and OSHA compliance
- Medical terminology and coding
- Microsoft Office proficiency
- NexTech and EPIC systems
- ClaimSource and TriZetto expertise
- Interpersonal and organizational skills
- Oral and written communication
- Multitasking and time management
- Credentialing processes and clearinghouse operations
- Financial analysis and revenue cycle management
References
Available upon request
Phone
mobile, 6307706818
Timeline
Director, Payor Management
Quick Med Claims
01.2021 - Current
Director, Patient Accounts
Pinnacle Dermatology
01.2019 - 01.2020
Insurance Follow-Up Manager
Boncura Health Solutions
01.2014 - 01.2019
EDI Processor
Boncura Health Solutions
01.2010 - 01.2014
Medical Assistant/Referral Coordinator
Fox Valley Women & Children’s Health Partners
01.2007 - 01.2009
Certified Medical Assistant -
Everest College
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