Isabel T. Medina
San Antonio
Summary
Medical billing professional with deep expertise in managing patient billing and insurance claims. Strong background in coding, account reconciliation, and compliance with healthcare regulations. Known for collaborating effectively with teams and adapting to changing needs to achieve optimal results. Reliable and detail-focused, ensuring accurate and timely processing of financial information.
Overview
24
24
years of professional experience
Work History
Medical Billing Specialist
Amazing Care Home Health Services
San Antonio, TX
10.2025 - Current
- Ensuring accurate claims information, including patient data, diagnoses and procedure codes
- Submitting claims on time to primary, secondary and tertiary payers
- Following up on denied or unpaid claims, including appeals and resubmissions
- Generating patient statements and invoices, including prior payments and the remaining balance
- Reconciling claims billing reports
- Posting payments to correct line items when received
- Develop and implement effective collections strategies to minimize outstanding accounts receivable and improve cash flow
- Analyze collection data to identify trends, challenges, and opportunities for improvement
- Collaborate with healthcare providers, payers, and internal departments to resolve billing discrepancies and optimize revenue recovery
Claims Resolution Analyst
Elevance Health
Indianapolis, IN
02.2016 - 07.2025
- Managed and resolved complex claim issues related to Texas Medicaid products, ensuring compliance with state regulations and accuracy in claim processing.
- Conducted in-depth reviews of provider demographics and contract configurations, identifying discrepancies and recommending system updates to align with Medicaid policies.
- Collaborated with internal departments and external healthcare providers to facilitate accurate claim reconsiderations and maintain strong provider relationships.
- Addressed and resolved formal State Complaints, serving as a liaison between providers, regulatory entities, and compliance leadership.
- Provided strategic feedback to Wellpoint's Regulatory Compliance team and the Health and Human Services Commission (HHSC) to support continuous process improvements.
Surgery Verification Coordinator
Christus Santa Rosa Physician Ambulatory Surgery Center
03.2015 - 01.2016
- Executed verification of insurance benefits in a high-volume environment, ensuring accurate communication of expected expenses to guarantors.
- Facilitated accurate demographic and insurance data management for patient accounts in response to scheduled appointment requests.
- Secured necessary insurance details to facilitate seamless surgical operations.
- Conducted thorough verification of patient eligibility and benefit packages to ensure accurate service delivery.
- Educated patients and clinical staff about financial obligations, ensuring understanding of co-payment collection, deductibles, and billing procedures based on financial status classification.
- Gathered critical data from PCP and HMO payers to facilitate timely managed care authorizations and pre-certifications, ensuring compliance with completion deadlines.
- Updated system with detailed notes on actions performed and insurance authorizations to maintain accurate records.
Surgery pre-authorization Coordinator
Northeast Orthopedics & Sport Medicine
07.2012 - 09.2014
- Conducted thorough verification of patients' insurance benefits to facilitate seamless service delivery.
- Managed the authorization process for surgical procedures to ensure compliance with healthcare regulations.
- Facilitated referral acquisition from PCP offices to ensure compliance with HMO insurance requirements.
- Facilitated acquisition of physical therapy and EMG referrals to ensure timely patient care.
- Executed follow-up procedures to confirm patient scheduling for physical therapy and EMG sessions.
- Coordinated patient scheduling for follow-up appointments post-study completion.
Surgery Scheduler
PRMA of South Texas
04.2012 - 06.2012
- Schedule patients for surgery
- Verify patients' insurance benefits and obtain authorization
- Write pre-determination letters and follow up weekly with insurance companies for status
- Advises patients and clinical staff regarding patient's financial responsibilities and explains co-payment collection, deductibles and the billing process based on the patient's financial status classification
Clinical Coordinator
The San Antonio Orthopedic Group
San Antonio, TX
05.2005 - 04.2012
- Assist physician & PA in clinic assure it runs smoothly and on time
- Triage phone calls
- Complete disability forms
- Call in medication recommended by physician
- Schedules patient for surgery and advises patients of pre-surgical requirements to include laboratory orders and/or x-rays.
- Entered orders and medication into EMR
- Entered charges for patient visits, surgeries, and hospital consults
- Obtain referrals from other health care providers/insurance carriers
- Submit pre-authorization for worker compensation
- Obtain authorization for all studies being ordered by physician
- Obtain authorization for medication refills
- Schedule consultations, x-rays, lab tests, physical therapy, MRI's, CT scans as recommended by the physician
- Schedule surgeries with the hospital and anesthesia
- Verify insurance benefits when needed
- Assist patients/visitors to determine nature of request or problem
- Proofread/correct claims prior to submitting to insurance companies
- Appeal denied claims for payment purposes
- Proof clinical office notes
- Oversees the day-to-day clinic activities and schedule to reduce patient wait times and reduce overtime expenses.
Accounts Receivable
HealthSouth San Antonio Surgery Center
11.2004 - 04.2005
- Submitting medical claims to insurance companies and payers such as Private insurance carriers, Medicare and Medicaid, ensuring accuracy and completeness of patient bills.
- Posting charges and payments to patient accounts, including adjustments according to contracts.
- Following up on unpaid claims within standard billing cycles and resolving discrepancies with insurance companies or patients.
- Reviewing insurance denials and resubmitting claims or filing appeals as necessary.
- Identifying secondary or tertiary insurance coverage and billing accordingly.
- Maintaining patient confidentiality and complying with HIPAA regulations.
- Performing routine audits of accounts to ensure all charges, payments, and adjustments are correctly applied.
- Communicating with patients, providers, and insurance companies to resolve billing issues and answer inquiries.
- Compiled and analyzed financial and statistical reports for accounts receivable and patient accounting.
Accounts Receivable Specialist
The Hand Center
06.2002 - 11.2004
- Review patient demographic entered billing system
- Post all incoming mail-in payment into the billing system
- Review and verify all payments and/or contractual negotiation agreements
- Review and prepare appeals on denials received from insurance carriers
- Review outstanding accounts receivable daily
- Communicated with insurance carriers and/or patients regarding outstanding balances
- Review and prepare refunds due to patient and insurance carriers
- Documents all contacts with carriers and or patients regarding outstanding balances
- Take necessary steps to obtain payment
- Maintains patient confidentiality
- Communicated and works closely with collection/insurance departments regarding outstanding balance
- Pick-up and sort mail
- Electronically send claims to carriers and audit reports for rejected claims
- Prepares paper claim as needed and mail out with required documentation as requested by insurance carrier
- Prepares Physician Liens when necessary
- Obtained surgery pre-certification when needed
- Checks the daily patient schedule and review all patient account for outstanding balance
- Assist front office including answering phones, filing and scheduling
- Assist with charges and payment entry of daily encounters
- ICD-9 AND CPT coding
Education
High School Diploma -
Brackenridge High School
San Antonio, TX05-1998
Principal of Accounting - Introduction to Business
St. Phillips College
San Antonio, TX08-1998
Skills
- Strong organizational ability, multi-task oriented, problem solving, fast accurate data entry, attention to detail, a self-starter, a team player and excellent customer service
- Microsoft Office, Excel, Access, Word, Outlook, and Ten Key by touch and 60 WPM
Timeline
Medical Billing Specialist
Amazing Care Home Health Services
10.2025 - Current
Claims Resolution Analyst
Elevance Health
02.2016 - 07.2025
Surgery Verification Coordinator
Christus Santa Rosa Physician Ambulatory Surgery Center
03.2015 - 01.2016
Surgery pre-authorization Coordinator
Northeast Orthopedics & Sport Medicine
07.2012 - 09.2014
Surgery Scheduler
PRMA of South Texas
04.2012 - 06.2012
Clinical Coordinator
The San Antonio Orthopedic Group
05.2005 - 04.2012
Accounts Receivable
HealthSouth San Antonio Surgery Center
11.2004 - 04.2005
Accounts Receivable Specialist
The Hand Center
06.2002 - 11.2004
Principal of Accounting - Introduction to Business
St. Phillips College
High School Diploma -
Brackenridge High School