Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

Flor Carbajal

Paterson,NJ

Summary


Detail-oriented and methodical Billing Specialist/Medical record offering Thirteen years of experience in related roles. Exceptional abilities in conducting research, problem-solving and prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills and superior work ethic for top job performance.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Billing Specialist/Medical Records Specialist

Turning Point Inc
05.2022 - Current
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Worked with multiple departments to check proper billing information.
  • Generated monthly billing and posting reports for management review.
  • Provided exceptional customer service to patients, addressing their concerns regarding insurance claims or billing issues with empathy and professionalism.
  • Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
  • Reduced errors in medical billings, effectively addressing discrepancies and rectifying issues promptly.
  • Optimized revenue generation through diligent monitoring of denied claims, resubmitting corrected information when needed.
  • Streamlined billing processes for faster reimbursement, utilizing advanced software solutions.
  • Generated reports to identify coding trends and discrepancies.
  • Followed up with medical staff regarding missing information in patient records.
  • Facilitated staff training on new billing software, enhancing team productivity and billing accuracy.
  • Reduced billing errors, leading to decrease in customer complaints, by conducting regular audits of billing data.
  • Handled account payments and provided information regarding outstanding balances.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.

Billing Specialist

Advance Housing Inc
01.2020 - 05.2022
  • Verify consumer eligibility for CSS billing
  • Add authorizations for CSS and NJMHAPP on foothold
  • Run the Clinical error report and email them to the appropriate staff
  • Process and generate CSS and OP billing to Medicaid
  • Process NJMHAPP billing steps on foothold
  • Add units on NJMHAPP website
  • Uploading remittance on foothold and process Medicaid breakdown by agency
  • Process and re-bill any denials and rejection to Medicaid
  • Report the prior week’s Medicaid CSS& OP and back billing Amounts
  • Verify original authorization from Medicaid on foothold.

PGM Physician Group Management LLC
01.2017 - 01.2020
  • Accurately applied payments to patient accounts
  • Research and resolved incorrect payments EOB rejections, and other issues with outstanding accounts
  • Monthly financial closing
  • Review all end of month closings
  • Review balance of client cash posting to general ledger
  • Reviews insurance Explanation of Benefits (EOBs) and posts payments, contractual allowances, and denials at the line item Run daily reports, research, and correct errors
  • Navigate insurance websites
  • Knowledge of EOB’S status
  • Maintain an update cash logs
  • Print and post checks as needed
  • Verification of benefits
  • Downloading payments on various programs
  • Sending DR’s ER’S weekly
  • Performs manual and electronic posting functions for all Managed Care, Commercial and Government payers for all patient accounts, including cash balancing and reconciliation of bank deposits
  • Complete monthly cash reconciliation on Excel spreadsheet
  • Scan the daily deposits into system
  • Downloading electronic payments (ERAs) from the clearing house
  • Balance daily payment Batch deposits
  • Payments verifies with outstanding balances
  • Processes batches and uses correct payment transaction type
  • Post cash and credit card payments
  • Makes transfers and corrections to patients’ accounts
  • Recognizing Overpayments/Credits and reporting to Refund Specialist(s).

Sartec Inc
01.2012 - 01.2016
  • Responsible for the maintenance of the patient’s documents and their demographics
  • Posting of insurance and patient payments (EOB)
  • Verification of insurance benefits
  • Processed patient’s billing, statements, claims, post transaction and data
  • Experience charge entry
  • Experience process secondary insurance claims for co-payments/coinsurance and deductibles
  • Experience in CPT and ICD-9 coding; Knowledge of medical terminology

Education

Medical Billing and Coding Specialist Program -

HOHOKUS-RETS school of Business, Medical and technical Sciences
Nutley, NJ
01.2011

Skills

  • CPT&ICD-9 Coding
  • Filling and charts
  • Medical Records
  • Medical Office Management
  • Microsoft Word
  • Microsoft Excel
  • Insurance Forms
  • Medicaid
  • Medisoft
  • Accounts Receivable
  • Financial Records & Reporting
  • Deposit Verification
  • Spreadsheets & Journal Entries
  • Billing software
  • Insurance verification
  • Claims processing
  • Financial reporting
  • Data entry proficiency
  • Denial management
  • Payment posting
  • Monthly billing management
  • Payment processing
  • Billing cycle management
  • Report generation
  • Analytical thinking
  • Month-end closing procedures
  • Claim submission

Certification

Medical Billing and Coding-HIPPA with privacy act

Languages

Spanish
Full Professional

Timeline

Billing Specialist/Medical Records Specialist

Turning Point Inc
05.2022 - Current

Billing Specialist

Advance Housing Inc
01.2020 - 05.2022

PGM Physician Group Management LLC
01.2017 - 01.2020

Sartec Inc
01.2012 - 01.2016

Medical Billing and Coding Specialist Program -

HOHOKUS-RETS school of Business, Medical and technical Sciences

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Flor Carbajal