Gloria Jaimes
Round Rock,Texas
Summary
Dedicated employee with over 15 years of exceptional customer service with knowledge of researching, analyzing, coordinating, and reconciling charge entries, as well as ensuring reimbursements from public/private payors. Excellent organizational, oral and written communication skills in both English and Spanish. Capable of working with limited supervision if needed, and comfortable while under pressure with project deadlines. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
26
26
years of professional experience
Work History
Accounts Examiner III
Comptroller Of Public Accounts
Austin, TX
03.2024 - Current
- Provide customer service assistance by phone to inquiries regarding taxes administered by the Comptroller office.
- Provide information to tax payers on sales, franchise taxes, and other taxes and fees.
- Perform moderate complex accounts examination work for tax payer services.
- Interpret request for information pertaining to tax forms, tax rules, and procedures, exempt status, and account status.
- Analyze the status of taxpayer accounts, and interpret computer-generated information.
- Perform complex mathematical computations for taxpayer accounts.
- Research, laws, rules, publications.
- Communicate information to tax payers.
- Enhance ongoing training knowledge on various tax laws, rules and policy changes.
- Assisted customers with online services and applications.
- Improved client satisfaction by addressing questions, concerns, and issues in a timely and professional manner.
- Identified discrepancies in accounts by carefully comparing documentation and transaction histories.
- Provided assistance on inquiries by determining information needed for resolution.
- Perform other duties as assigned.
Certified Medical Coder/ Reimbursement Coordinator
Ascension Seton Medical Group
Austin, TX
06.2015 - Current
- Monitor and review daily activity, data while processing claims.
- Maintain patient related information, updated notes, charts, and account changes.
- Track and report clinic metrics, and accomplishments and areas of improvements.
- Knowledge with appending modifiers to meet coding guidelines as well as payer specific modifiers needed to bill out claims
- Knowledge of global period billing guidelines and non-billable bundling policy guidelines
- Complete simple audits for accuracy and compliance with guidelines, file appeals and file corrected claims
- Utilize clinical and coding knowledge to ensure accurate and compliant charge entry items and to recognize and resolve billing inconsistencies
- Query providers and medical staff when documentation is unclear or not straightforward for coding purposes
- Post charges and adjust charges if applicable on office visits, and procedures and perform mathematical calculations for patient responsibility charges when necessary.
- Research, analyze and verify documentation and accounts.
- Verify and perform reconciliation of payments between reports
- Review and confirm demographics and insurance information and correct any data entry errors, while educating staff and departments to improve workflow processes for efficiency in capturing all billing and revenue cycles as possible
- Responsible for Missing slips, Ingenious Med billing, A/R follow up, and creating new accounts, all while keeping everything within the department required matrix
- Able to analyze errors in claim denials and dispute them if necessary while providing recommendations for process improvements
- Register patients and verify insurance eligibility in various systems.
- Improved accuracy of medical coding by thoroughly reviewing patient records and assigning correct codes for diagnoses and procedures.
- Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
- Protected patient confidentiality by adhering strictly to HIPAA regulations when handling sensitive information related to medical records, treatments, and diagnoses.
- Ensured data integrity by meticulously auditing coded data, verifying its accuracy, and making necessary adjustments as needed.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Provide professional and timely customer service to clients as well as to co-workers.
- Research and process client and internal issues and inquiries, while reporting the findings and resolutions within a timely follow up with staff and clients.
- Maintained compliance with industry regulations by staying up-to-date on the latest changes in medical coding guidelines and conventions.
- Provide departmental staff direction of workflows, data and procedures.
- Recommend improvements on identified inefficiencies.
- Cross train, and provide back up support to other areas in the department.
- Perform other duties as assigned.
Clinical Office Manager for Pediatric Endocrinology
Ascension Seton Medical Group
10.2013 - 12.2014
- Managed 5 clinic offices and over 40 employees with direct reports to Operations Managers
- Worked directly with Operations Manager, Clinic Providers and Billing Manager
- Responsible for overseeing Clinic Dashboard in Athena, and clearing claim hold buckets, which included encounters not being closed, wrong insurance plans, demographics, eligibility, and charge entry errors
- Over see that front desk personnel completed daily reconciliation
- Posted payor and customer payments in eCW and Medman database
- Assist Billing Manager with inpatient tickets
- Served as an effective mediator for parent concerns or complaints by phone or in person
- Interpreted and applied applicable laws, policies, procedures, and controls to develop new strategies and systems with Operations Manager and Clinic Providers
- Reconciled invoices for all area laboratories (CPL, Quest, LabCorp)
- Developed comprehensive training programs for new hires, fostering a supportive work environment that encouraged professional growth.
- Enhanced office productivity by overseeing daily operations, managing staff schedules, and allocating resources effectively.
- Collaborated with healthcare professionals to develop effective strategies for addressing clinic-wide challenges such as staff shortages or high-patient volume periods.
- Optimized office workflow by analyzing existing processes, identifying areas for improvement, and introducing innovative solutions to increase efficiency.
- Conducted regular performance evaluations for clinical staff members, providing constructive feedback and setting goals for continuous improvement in their roles.
- Facilitated cross-functional collaboration within the clinic to promote teamwork amongst various departments leading to better patient experiences on all levels of care delivery.
- Managed expense reports accurately and promptly submitted reimbursements requests to ensure timely compensation for staff-related expenses.
- Oversaw appointment scheduling and itinerary coordination for both clients and personnel.
- Processed reviewed and analyzed payments from clients and payers.
- Provided professional and timely customer service to both Spanish and English speaking clients.
Senior Customer Service Representative
Ascension Seton Medical Group
Austin, TX
03.2007 - 12.2013
- Scanned insurance card, and photo id, collected copays or deductibles when necessary, reconciled at the end of the day
- Posted payor and customer payments in eCW and Medman database
- Accurately sorted and attached corresponding documentation to the patient's chart
- Facilitated effective communication regarding medical appointments and procedures with bilingual families
- Verified insurance eligibility by phone or internet for all scheduled appointments while maintaining proper insurance authorization if needed by plan from Primary Care Physician offices
- Facilitated payment arrangements with the Self Pay coordinator.
- Provided backup support during peak periods or staff shortages to ensure seamless service delivery to clients at all times.
- Resolved customer service issues using company processes and policies and provided updates to customers.
- Demonstrated excellent multitasking abilities by managing multiple concurrent tasks while ensuring timely completion.
- Engaged clients in person and over phone to answer questions and address complaints.
- Enhanced customer satisfaction by promptly addressing and resolving complex inquiries and complaints.
Administrative Assistant
Lonestar Materials Inc.
Austin, TX
08.1998 - 02.2007
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Promoted inside, outside, and counter sales, while dispatching all sales and placing in proper designation of pick up or delivery.
- Reviewed daily activity for balances, sales, and inventory to ensure consistency and accuracy of sales.
- Provided professional customer service interaction, both in English and Spanish.
- Balanced cash register and petty cash drawer at the end of the day.
- Reviewed, analyzed, and processed daily payments from clients.
- Assisted accounts payable with invoices, and acquiring proper Resale Certificate for non-profit sales
- Supported accounts receivable team with completion of liens, daily deposits, and posting payments to customer accounts
- Provided back up and supported other departments, while cross training other staff.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Ensured accurate record-keeping with diligent data entry and database management for vital company information.
- Received and sorted incoming mail and packages to record, dispatch, or distribute to correct recipient.
- Restocked supplies and placed purchase orders to maintain adequate stock levels.
- Streamlined invoice processing procedures to ensure timely payment of vendors while minimizing errors in financial records.
- Processed customer orders accurately and within agreed timeframes to meet service standards.
- Performed other duties as assigned
Education
Principles of Accounting -
Austin Community College
Austin06.2023
Quickbooks Certification -
Austin Community College
Austin06.2023
Certified Professional Coder -
AAPC
Austin, TX03.2021
Texas ParaEducator Certificate -
Austin Community College
Austin10.2009
Skills
- Expense Tracking
- Basic accounting principles
- Payment Processing
- Bank Reconciliation
- Accounts receivable management
- Payment plan processing
- Clinical Documentation Review
- Continuing Education Commitment
- Medical claims coding
- Appeals and Adjustments Handling
- CPT coding knowledge
- Claims Processing Efficiency
- Critical thinking abilities
- Data Entry Speed
- Clinical Workflow Optimization
- Medical billing and coding
- Quality Assurance and Improvement
- Office Administration
- Customer Service
- Data Entry
- Computer Skills
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Critical Thinking
Languages
Spanish
Native or Bilingual
Timeline
Accounts Examiner III
Comptroller Of Public Accounts
03.2024 - Current
Certified Medical Coder/ Reimbursement Coordinator
Ascension Seton Medical Group
06.2015 - Current
Clinical Office Manager for Pediatric Endocrinology
Ascension Seton Medical Group
10.2013 - 12.2014
Senior Customer Service Representative
Ascension Seton Medical Group
03.2007 - 12.2013
Administrative Assistant
Lonestar Materials Inc.
08.1998 - 02.2007
Principles of Accounting -
Austin Community College
Quickbooks Certification -
Austin Community College
Certified Professional Coder -
AAPC
Texas ParaEducator Certificate -
Austin Community College