Gerica Caballero
Summary
Detail-oriented and bilingual professional with extensive experience in client communication, data management, and administrative support, seeking to contribute to Orange County Surgical Specialists. Adept at coordinating appointments, managing documentation, and facilitating smooth communication between clients and healthcare providers. Committed to delivering exceptional service in a fast-paced, team-oriented environment while maintaining the highest standards of accuracy and professionalism.
Overview
12
12
years of professional experience
Work History
DMH Billing COORDINATOR and quality assurance
children’s institute
01.2013 - Current
- Perform data entry and administration of provider data into the systems required for claiming their services; verifies and administers client eligibility data in support of claims; processes and submits claims and claim explanation of benefit (EOB) response files using Exym & MyAvatar and paper-based forms in a timely manner; ensures claims compliance with Medi-Cal, DMH, and MyAvatar rules
- Maintains detailed records on submitted claims, claim status, and all status issues that may result in non-payment; reports claim issues to a supervisor with recommendations on follow up
- Maintains detailed records on amended claims and deleted claims to be submitted yearly to LAC-DMH, Void report
- Performs data entry and administration of provider data into the systems required for claiming their services; verifies and administers client eligibility data in support of claims; processes and submits claims and claim explanation of benefit (EOB) response files using Exym & MyAvatar and paper-based forms in a timely manner; ensures claims compliance with Medi-Cal, DMH, and MyAvatar rules
- Monitor and analyze claims cycles for any issues, errors, and rule violations before submission; resolve issues and/or report problems to the supervisor
- Research and resolve the claim with issues preventing the claims from being submitted to payors or that resulted in denials, including billing related violations in the Exym & MyAvatar EHRS; researches state Medi-Cal and local LAC-DMH and SBC-DBH claim denials; implement the fix in Exym & MyAvatar or escalates and follows-up with others as necessary
- Research and resolve any local LAC-DMH and EXYM file rejections that result from technical transaction format and other issues
- Runs claim related reports, reviews, and follows-up on apparent issues in these reports; research and resolves or escalates to others as necessary
- Creates, runs, and maintains designated annual and semi-annual corporate reports for program staff; utilizes Exym & MyAvatar Unbilled report to create the monthly reconciliation data
- Collaborates/communicates with members of DMH, Quality Assurance, Therapist, Clinical supervisors, Charts and Records, and Finance teams on issues relating to eligibility and unbilled services
- Performs related clerical duties including filing, answering the telephone, copying/collating documents, and preparing routing correspondence
- Communicate with FP supervisors to ensure that DCFS billing manual data entry is completed in a timely manner, and that all contracts are signed and mailed out to DCFS
- Initiated and conducted client calls to schedule intake registration appointments, ensuring timely and efficient onboarding
- Reviewed and explained insurance coverage and consent forms to clients, ensuring full understanding and compliance
- Collected and verified intake registration documentation from clients to ensure accurate and complete records
- Discussed child abuse reporting requirements and reviewed privacy notice with clients to ensure confidentiality and compliance
- Requested and obtained necessary client documentation, including medical records (MC), Social Security number (SS), and identification (ID)
- Uploaded client documentation into electronic health records (EHR) system, ensuring accurate and up-to-date information
- Collaborated with clinical supervisor and therapists to streamline and improve the intake process, enhancing client experience and operational efficiency
Education
Associate of Arts - Fine Arts
EL CAMINO COLLEGE
06.2024
Skills
- Excel
- Attention to Detail
- Strong Communication Skills
- Typing
- Zoom
- Microsoft Teams
- Deadline oriented
- Data entry proficiency
- Customer service
- Claims processing
- Research
- Billing software
Languages
Spanish
Full Professional
Timeline
DMH Billing COORDINATOR and quality assurance
children’s institute
01.2013 - Current
Associate of Arts - Fine Arts
EL CAMINO COLLEGE
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