ITZIAR DE LOS ANGELES
Miami
Summary
Experienced Medical Claims Processor/Examiner with a proven track record in medical billing, coding, and records management. Specializing in maintaining high quality standards, optimizing collections, and delivering exceptional customer service across International and Domestic accounts. Skilled at analyzing complex data and developing strategic plans to achieve organizational objectives. Recognized for coordinating cross-functional teams and driving productivity without constant supervision. Highly self-motivated with unwavering energy to excel in all tasks.
Overview
27
27
years of professional experience
Work History
Insurance Collections Specialist II
Miami Cancer Institute
01.2014 - Current
- Verified CPT and ICD-10 codes annually, minimizing denials due to expired codes
- Increased frequency of assessing insurance payment trend/collection patterns to quickly identify denials and outstanding claims
- Provide insurance companies with additional documentation or records (if requested) to expedite payments and resolve denials
- Investigated and resolved insurance company disputes and communicates with patients regarding account balances and claim statuses
- Verified patient insurance information to ensure timely processing of claims
- Demonstrated knowledge of HIPAA Privacy and security regulations by appropriately handling patient information
- Efficiently performed insurance verification and pre-certification and pre-authorization functions
- Recommends new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services performed
- Documented in patient accounts with actions taken to resolve issues
- Performed in depth analysis of inquiries and complaints and compose appeal letters for clients
- Follow up on appeals and rebills in a timely manner
- Ability to read, interprets, and analyzes documents such as reports, guidelines, plan documents and summary plan descriptions
- Used Internet and hard copy tools to research issues using federal laws and regulations relevant to CMS policies
Patient Finance Associate
Jackson South Community Hospital
01.2011 - 01.2013
- Responsible for completing an efficient and organized registration, admission and insurance verification of all inpatients and outpatients
- Confirm patient insurance eligibility and/or benefits
- Prompt response to e-mail and telephone calls
- Work with eligible patients to apply for applicable assistance programs
- Understand the functional status and physical needs of patients
- Assist surgical, radiology, physical therapy and/or breast center scheduling as required or assigned
- Performs other necessary duties to provide excellent customer service
- Patient payment posting
- Manages operations relative to patient bed assignments
- Provide an explanation of billing policies, procedures and point-of-service collections
- Discuss what co-pays, deductibles and coinsurance are due for the patient’s visit – and arranges for payment of co-pays, deductibles and coinsurance
- Negotiate payment arrangements depending on the situation
- Authorization verification for all outpatient procedures, surgeries as well as observation or inpatient stay
- Arrange and assist with hospital admissions
Health Department Supervisor
AFTA, Insurance Services
01.2011 - 12.2011
- Direct and coordinate activities in the Health, Life and Casualty of an insurance broker agency
- Review, settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures
- Confer with legal counsel on claims requiring litigation
- Interact with customers to provide information in response to inquiries about products and services and handle and resolve complaints
- Analyze the extent of the insurance company’s liability concerning health, life or casualty in attempted to settle the claim
- Interview or correspond with claimants, medical specialist and insurance agents to compile information
- Prepared insurance forms for purpose of settling the claim with the insurance carrier
- Process new insurance policies, modifications to existing policies, and claim forms
- Review insurance applications to ensure all questions have been answered
- Obtain information from policy holders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records; in addition, verify the accuracy of insurance company records
- Updated existing policies and company records to reflect changes requested by policyholders and insurance company representatives
- Process applications for changes to reinstatement of, and cancellation of insurance policies
Medical Claims Processor
BUPA Latin America Insurance
01.2010 - 12.2010
- Review, evaluate and process international and domestic claims for payment
- Ensure all pending claims are within established deadlines and company objectives
- Verify pre-authorization, claim form, medical records, documents, provider invoices/bills are pertinent to the claim and to the patient
- Review policy for exclusions, limitations, deductible or pre-existing conditions
- Determines if claims submitted are subject to coordination of benefits
- Request additional medical records or documents needed to process the claim
- Ensure UCR guidelines and billing currency
- Help out in pre-processing and data entry department when needed
Executive Assistant
Glisco Engineering, Inc.
01.2009 - 01.2010
- Executive assistant to COO and CEO
- In charge of archiving and filing all company documents
- Oversee contracts, quotes and invoices for Projects were done in a timely manner
- Scheduled and organized clients, vendors and subcontractors meetings
- Translated all reports, letter, contracts and documents (English/Spanish)
General Manager
Medic Solutions Int’l
01.2004 - 01.2009
- Director of a Medical Billing Company overseas
- Devised a marketing program for introducing a concept where none previously existed
- Review all medical records and patient information for data entry process
- Created claims (CMS form) based on medical documents
- In charge of medical coding (ICD-9 & CPT) for all medical specialties
- Submitted all medical claims within the time limit
- In charge of the collections and follow up for all international accounts
- Served as a consultant for medical providers and medical facilities in Panama and Costa Rica
- Offered translations services for medical records
- Supervised human resources department
- Managed workflow in an office of five
- Responsible for national and international sales services
- Trained incoming employees for all available positions
Medical Coder Specialist
Alliance One, Inc.
01.2000 - 01.2004
- Responsible for the quality department
- This included personnel of about five and the 'Edits Report'
- Careful review and correction of any errors in demographics, insurance information, authorizations, modifiers and coding
- In charge of sorting and coding medical reports; also helped in charges and payment posting
- Helped distribute and organized projects in a department of about ten employees, and trained incoming employees as collectors
- Responsible for filing and following up on medical claims past ninety days
- Coordinated all medical records and payment logs for ER, Pathology, Radiology, Anesthesia and Oncology
- Responsible for special project: Medical Records, Appeals and Affidavits, Reviewing and Restructuring of Contracts, and Write-offs
- Implemented more efficient methods to collect and appeal pending accounts
Medical Coding Specialist –Intern
Franklin Llanes, M.D.
01.1999 - 01.2000
- Responsible for data entry of patient information, filing medical claims, insurance authorizations and referrals, payment posting, coding CPT-4 and ICD-9 books, and answering multi-line phone
Receptionist/Clerk
Blue Cross & Blue Shields
01.1998 - 01.1999
- Responsible for receiving and filing members information, correspondence and RNL’s clerk during HEIDIS project
Education
Medical Administration/Medical Coding Specialist - Medical Coding Honor Student, Medical Terminology, Human Anatomy & Physiology, Clinical Pathology, Hospital Billing and Claims Processing, Business Principals & Ethics, Medical Records, Insurance Regulations, Florida Statutes and Rules, Coding Cases Studies I, II, III, ICD-9, Cpt-4, HCPC, Cardiopulmonary Resuscitation and First Aid
National School of Technology
Miami, Florida01.2000
Skills
- Microsoft Office
- Word
- Excel
- PowerPoint
- Outlook
- Publisher
- Adobe
- Cerner
- Emdeon
- E-cashing
- Availity
- Medicaid
- Medicare provider portal
- 3M Encoder
- Amigos
- Imaging
- CalMed
- Encoder-Pro
- Fiscal System
- Lytec
- Vital Works
- Med Aid
- Med Flex
- Medisoft
- Insurance payment regulations
- Reimbursement schemes
- Coinsurance
- Deductibles
- Contractual adjustments
- Medicare
- Managed Care
- Workman’s Compensation
- Tricare
- VA
- FMP
- Commercial insurances
- Medical Billing
- Collections
- Insurance follow up
- Medical Coder Specialist
- E/M
- ICD-9
- CPT-4
- HCPC’s
- NDC’s
Languages
Spanish
Native or Bilingual
Timeline
Insurance Collections Specialist II
Miami Cancer Institute
01.2014 - Current
Patient Finance Associate
Jackson South Community Hospital
01.2011 - 01.2013
Health Department Supervisor
AFTA, Insurance Services
01.2011 - 12.2011
Medical Claims Processor
BUPA Latin America Insurance
01.2010 - 12.2010
Executive Assistant
Glisco Engineering, Inc.
01.2009 - 01.2010
General Manager
Medic Solutions Int’l
01.2004 - 01.2009
Medical Coder Specialist
Alliance One, Inc.
01.2000 - 01.2004
Medical Coding Specialist –Intern
Franklin Llanes, M.D.
01.1999 - 01.2000
Receptionist/Clerk
Blue Cross & Blue Shields
01.1998 - 01.1999
Medical Administration/Medical Coding Specialist - Medical Coding Honor Student, Medical Terminology, Human Anatomy & Physiology, Clinical Pathology, Hospital Billing and Claims Processing, Business Principals & Ethics, Medical Records, Insurance Regulations, Florida Statutes and Rules, Coding Cases Studies I, II, III, ICD-9, Cpt-4, HCPC, Cardiopulmonary Resuscitation and First Aid
National School of Technology
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