Heather Gonzalez

Responsible for day to day process of claims research and resolution , which includes review of medical claims , contracts and fee schedules to identify processing , procedural and billing errors.

Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processing

Running ML reports for my supervisor

Making calls to providers daily

Reviewing , typing and sending out all Spanish denial letters for my team

Monitoring the denial queues daily for compliance

Maintain a high production of 25+ per day

Request special checks when needed

I am responsible for 7 IPAs and many providers and have established relationships now, senior eligibility and all Spanish related work

I help my team when needed

Trained both new hires within the last 3 years

I work with Microsoft word, excel , Outlook and teams

• Paid or denied medical claims based upon established claims processing criteria.
• Verified patient insurance coverage and benefits for medical claims.
• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
• Assessed medical claims for compliance with regulations and corrected discrepancies.
• Managed large volume of medical claims on daily basis.
• Monitored and updated claims status in claims processing system.
• Reviewed provider coding information to report services and verify correctness.
• Evaluated medical claims for accuracy and completeness and researched missing data.
• Identified and resolved discrepancies between patient information and claims data.
• Used administrative guidelines as resource or to answer questions when processing medical claims.

• Evaluated medical claims for accuracy and completeness and researched missing data.
• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
• Verified patient insurance coverage and benefits for medical claims.
• Monitored and updated claims status in claims processing system.
• Managed large volume of medical claims on daily basis.
• Paid or denied medical claims based upon established claims processing criteria.
• Identified and resolved discrepancies between patient information and claims data.
• Used administrative guidelines as resource or to answer questions when processing medical claims.
• Followed up on denied claims to verify timely patient payment and resolution.
• Assessed medical claims for compliance with regulations and corrected discrepancies.
• Processed insurance payments and maintained accurate documentation of payments.
• Researched and resolved complex medical claims issues to support timely processing.
• Reviewed provider coding information to report services and verify correctness.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Generated, posted and attached information to claim files.
• Checked documentation for accuracy and validity on updated systems.
• Processed and recorded new policies and claims.
• Maintained confidentiality of patient finances, records, and health statuses.
• Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
• Posted payments to accounts and maintained records.
• Modified, updated and processed existing policies.
• Calculated adjustments, premiums and refunds.

• Communicated with insurance providers to resolve denied claims and resubmitted.
• Verified insurance of patients to determine eligibility.
• Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
• Posted payments and collections on regular basis.
• Collected payments and applied to patient accounts.
• Reviewed patient records, identified medical codes, and created invoices for billing purposes.
• Reviewed patient diagnosis codes to verify accuracy and completeness.
• Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
• Adhered to established standards to safeguard patients' health information.
• Filed and updated patient information and medical records.
• Prepared billing statements for patients and verified correct diagnostic coding.
• Liaised between patients, insurance companies, and billing office.
• Delivered timely and accurate charge submissions.
• Audited and corrected billing and posting documents for accuracy.
• Used data entry skills to accurately document and input statements.
• Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
• Maintained accurate records of customer payments.
• Created improved filing system to maintain secure client data.
• Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
• Kept vendor files accurate and up-to-date to expedite payment processing.