Guadalupe Quintana
Hemet,CA
Summary
Experienced with medical billing and insurance claim processes, ensuring accurate and timely submissions. Utilizes problem-solving skills to address and resolve billing discrepancies efficiently. Knowledge of medical terminology, coding standards, and insurance policies.
Overview
14
14
years of professional experience
Work History
MEDICAL BILLER
Rady Children's Hospital
10.2019 - Current
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Filed and updated patient information and medical records.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Maintained compliance with industry regulations by staying updated on changes to medical billing codes and requirements.
- Negotiated with insurance providers to resolve payment disputes, ensuring fair compensation for services rendered.
- Reduced instances of denied claims, carefully reviewing and rectifying coding errors before submission.
- Enhanced accuracy of insurance claims with meticulous verification and updating of patient records.
- Maintained up-to-date knowledge of billing software and healthcare regulations, contributing to department's compliance and efficiency.
BILLING MANAGER
Medical Oncology Associates
03.2011 - 10.2019
- Reviewed billing problems, researched issues, and resolved concerns.
- Managed monthly billing process to complete billings and returns to meet company revenue recognition policies.
- Trained and mentored staff on procedures, compliance requirements, and collections techniques.
- Collaborated with cross-functional teams to resolve billing-related issues swiftly, minimizing negative impacts on overall operations.
- Reduced errors and discrepancies in invoicing by closely monitoring billing data and conducting regular audits.
- Implemented policies that improved accounts receivable collections, resulting in reduced outstanding balances and increased cash flow.
- Boosted team productivity through effective delegation of tasks, setting performance targets, and providing constructive feedback.
- Conducted performance reviews and implemented improvement plans.
- Worked with customers to develop payment plans and bring accounts current.
- Performed testing for billing modules, enhancing new functionality and process improvements.
- Developed a strong rapport with key stakeholders by maintaining open lines of communication and promptly addressing any concerns raised.
- Established performance metrics for evaluating staff effectiveness, leading to continuous improvement initiatives within the department.
- Cultivated culture of continuous improvement, encouraging team members to propose innovative solutions for billing challenges.
Education
High School Diploma -
CASTLE PARK HIGH SCHOOL
CHULA VISTA07-1987
Skills
- Insurance claims processing
- Claim submission
- Payment posting
- ICD-10
- Claims review
- Medical claims submission
- CERNER
- Account follow-up
- Multitasking
- Multitasking Abilities
- Billing Systems
Languages
Spanish
Full Professional
Timeline
MEDICAL BILLER
Rady Children's Hospital
10.2019 - Current
BILLING MANAGER
Medical Oncology Associates
03.2011 - 10.2019
High School Diploma -
CASTLE PARK HIGH SCHOOL
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