Isaura Martinez
Dallas,Texas
Summary
Experienced professional with comprehensive knowledge of medical insurance billing, coding, eligibility, and reimbursement procedures, specializing in professional billing with over 15 years of experience
Overview
17
17
years of professional experience
Work History
Quality Assurance Specialist I
UT Southwestern Medical Center
02.2023 - Current
- Performs quality assurance audits within revenue cycle departments
- Produces reports summarizing audit discoveries and maintains records of findings
- Ensures that billing is optimized, and errors are minimized by identifying improvement opportunities
- Evaluates medical claims to ensure that quality, accuracy, timeliness, and standards are met
- Assists in the management and maintenance of the standard operating procedure (SOP) library
Billing Specialist III
UT Southwestern Medical Center
11.2021 - 02.2023
- Accountable for identifying and resolving provider enrollment denials, rejections and edits
- Responsible for recognizing billing trends involving various departments and payers
- Resolving processes included submitting reconsiderations, appeals, corrected claims, replacement claims and updating registration
- Establishing workflows and assisting with developing SOPs
- Providing support for training
- Accountable for high-value and high-volume workqueues
- Identifying and researching updates to billing claim forms and notifying Information Resources
- Meeting quality & assurance and exceeding productivity
Technical Denial Management Specialist III
UT Southwestern Medical Center
04.2021 - 11.2021
- Analyzing, investigating and solving claim edits, rejections and denials for professional billing for commercial and government payers
- Providing guidance on billing rules and registration filing order rules
- Advising of new reimbursement policy changes regarding provider enrollment
- Conducting verification of provider enrollment for Medicare, TMHP, Tricare, Out of State Medicaid, BCBS, and other managed care payers
Technical Denial Management Specialist II
UT Southwestern Medical Center
09.2020 - 04.2021
- Conducting comprehensive investigations and addressing the resolution of denials from Medicare, Medicaid, and Commercial payers
- Denial types include provider enrollment, non-covered, authorization, max benefit, non-contracted, eligibility, attachments, past timely, duplicates and others
- Crossed trained in areas such as Agency, Out of State Medicaid, Tricare, and other areas
- Generating Excel reports for managerial review
Billing Specialist II
UT Southwestern Medical Center
11.2019 - 09.2020
- Responsible for reviewing and submitting charges ensuring compliance with coding & billing policies for physical therapy services
- Accountable for technical and clinical denials optimizing maximum reimbursement
- Responsible for reviewing claim editing claims by to ensure acceptance and minimize rejections and denials
- Assisting with patient registration and appointments
- Ensuring timely resolutions in accordance with payor deadlines
- Remaining informed about updated coding and billing policies
Technical Denial Management Specialist II
UT Southwestern Medical Center
04.2018 - 11.2019
- Reviewing, researching, and addressing technical claim denials, including submission of appeals, resolution of rejected claims, and updating patient registration
- Responsible for identifying trends in billing denials and preparing special project reports for Managed Care Operations
- Informing the provider enrollment department about providers that are not enrolled in Medicare and Medicaid as identified in the workqueue inventory
- Maintaining SharePoint inquiries regarding follow-up
Office Manager
My DFW Woundcare
09.2015 - 09.2016
- Overseeing billing, coding, reimbursements, insurance verifications and benefits for wound care services
- Establishing and implementing office policies and procedures
- Managing credentials and licenses
- Recruiting and training office personnel
- Monitoring insurance and patient aged trial balance reports
- Regulating billing statements and collections processes
Ophthalmic Medical Coder and Biller
G.S. Payseur, MD PA
01.2008 - 09.2014
- Responsible for the coding, billing, reimbursement, and collections aspects of the ophthalmic revenue cycle for professional billing services
- Including verifying eligibility & benefits, obtaining referrals and authorizations, coding rendered services, submitting claims, resolving claim denials, payment posting, submitting patient statements, handling collections, managing insurance and patient aged trial balance reports
- Evaluating and analyzing the coding of diagnostic and treatment procedures documented in medical records
Education
Some College - Psychology & Child Development
The University of Texas At Dallas
Richardson, TXSkills
- EMR systems such as Epic, Cerner, and Dr Chrono
- Microsoft 365
- CPT and ICD 10
- RARC & CARC
- Medicare and Medicaid processes
- Familiar with provider portals such as Waystar, Availity, UHC, TMHP, Novitasphere, PECOS, and NPPES
Timeline
Quality Assurance Specialist I
UT Southwestern Medical Center
02.2023 - Current
Billing Specialist III
UT Southwestern Medical Center
11.2021 - 02.2023
Technical Denial Management Specialist III
UT Southwestern Medical Center
04.2021 - 11.2021
Technical Denial Management Specialist II
UT Southwestern Medical Center
09.2020 - 04.2021
Billing Specialist II
UT Southwestern Medical Center
11.2019 - 09.2020
Technical Denial Management Specialist II
UT Southwestern Medical Center
04.2018 - 11.2019
Office Manager
My DFW Woundcare
09.2015 - 09.2016
Ophthalmic Medical Coder and Biller
G.S. Payseur, MD PA
01.2008 - 09.2014
Some College - Psychology & Child Development
The University of Texas At Dallas
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