Helena Aguilar
Fresno
Summary
Analytical Medical Biller successful at resolving disputes and billing inquiries. Detail-oriented individual with 10 years of experience performing intricate billing procedures with undeniable level of detail. Familiar with private and commercial insurance carriers.
Overview
10
10
years of professional experience
Work History
Claims Integrity Specialist
IRhythm Technologies Inc.
02.2021 - 12.2023
- Verified insurance coverage of medical claims to ensure accurate reimbursement.
- Researched discrepancies between provider-submitted documentation and payer requirements.
- Conducted detailed analysis of medical records to determine eligibility for services covered by insurance plans.
- Submitted appeals on behalf of providers when necessary due to denied or underpaid claims.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Documented file notes clearly and concisely in Salesforce.
- Collaborated with fellow team members to manage large volume of claims.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Medical Billing Specialist
C Care Solutions
Fresno
06.2020 - 10.2020
- Followed up on unpaid or denied claims in a timely manner.
- Analyzed account receivables aging report to identify delinquent accounts.
- Responded promptly to customer inquiries regarding billing disputes or discrepancies.
- Conducted billing calls, questions and concerns from patients and third party carriers.
- Corrected, completed and processed claims for payer codes.
- Submitted claims to insurance companies.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
Revenue Integrity Specialist
Saint Agnes Medical
Fresno
09.2019 - 05.2020
- Conducted chart reviews using established criteria to evaluate the appropriateness of services rendered.
- Identified discrepancies between patient charts and actual care provided, making corrections as needed.
- Monitored progress of projects related to improving charting accuracy throughout an organization.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Processed patient admission and discharge documents.
Medical Billing Representative
Adventist Health
Hanford
04.2014 - 09.2019
- Reviewed and processed medical insurance claims for accuracy, completeness and compliance with insurance regulations.
- Maintained accurate records of all billing activities in accordance with HIPAA standards.
- Resolved any discrepancies or errors in billing documents through research and negotiation with payers.
- Responded to inquiries from providers and managed disputes related to unpaid claims.
- Conducted follow-up calls with third party payers to check on claim status and resolution.
- Updated patient demographics such as address changes or insurance coverage updates within practice management system.
- Submitted refund requests for claims paid in error.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Completed and submitted appeals for denied claims.
Education
Administrative Health Care Management - Medical Billing
San Joaquin Valley College
Hanford, CA04-2014
High School Diploma -
Riverdale High School
Riverdale, CA07-1997
Skills
- Commercial And Private Insurance
- Medical Billing / AR-Follow
- Medical Terminology
- MS Excel
- Epic, Cerner, workforce, Xifin, SSI
- remote
- Hospital / Physician Billing
- Patient Information Management
- Revenue Cycle Management
- Spreadsheet Management
- Medical Records
- Full Cycle Claims Processing
References
References available upon request.
Timeline
Claims Integrity Specialist
IRhythm Technologies Inc.
02.2021 - 12.2023
Medical Billing Specialist
C Care Solutions
06.2020 - 10.2020
Revenue Integrity Specialist
Saint Agnes Medical
09.2019 - 05.2020
Medical Billing Representative
Adventist Health
04.2014 - 09.2019
Administrative Health Care Management - Medical Billing
San Joaquin Valley College
High School Diploma -
Riverdale High School
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