JACQUELINE ORTEGA
PO BOX 833293 Richardson,TX
Summary
Experienced Medical Billing Specialist & coding with 15 years of demonstrated experience in a fast-paced office setting, multiple client medical billing companies. Working as an A/R Rep II /Medical Billing with Coding and collections back round. Seeking and maintaining a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management, and problem-solving skills. Enthusiastic and eager to contribute to team success through hard work, attention to detail, and excellent organizational skills. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
20
20
years of professional experience
Work History
Medical Billing Skilled Home Health /Liaison
Elara Caring, Dba Jordan Health Care
Addison, TX
04.2020 - Current
- Home health services for, care and home-based care services to seniors, adults, and children with disabilities
- Billing (HC HB System )commercial claims 1500 claims, UB04, Insurance Carriers; Anthem BCBS, Hoosier health, UHC VA CCN OPTUM, Indiana Medicaid, Priority Health VA Northern Indiana, etc
- Uploaded all claims utilizing Zirmed –way star clearinghouse to process all claims.
- Established, Corrected rejections and denials, corrected CPT codes & modifiers, rev codes,
- Corrected VA claims with incorrect prior authorization numbers, corrected units/days billed per each insurance contract/ utilizing updated VA fee schedule & CMS website.
Medical Billing Specialist Private Duty /Self Pay
Elara Caring, dba Jordan Health Care
Addison, TX
05.2019 - 04.2020
- Revenue gain retrieve from billing self-pay patients Long Term HealthCare Senior Citizen for Home Health Care, RN, LPN, HHAID
- Commercial Billing 1500 claim and UB 04 forms utilizing Home Care Home Base system and Arrow system
- Credit & Collections tasks, retrieving patients' credit cards for payments monthly or daily and working Account Receivable over 120 days old
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Prepared billing correspondence and maintained all databases to organize billing information.
- Resolved problems, improved operations, and provided exceptional service
Authorization Specialist
Elara Caring dba Jordan Health Care
Addison, TX
03.2019 - 05.2019
- Contacting Home Bound patient's insurance BCBS Cigna /Health spring, etc for Home health care services
- Retrieving authorization for skilled nursing services, providing physical therapy, speech therapy services, etc
- The main procedure utilized to retrieve care G0299, G0151, G0152, G0155, etc
- Patient's accounts are created in the Home Care Home Base system, patients' accounts are documented and billed, and utilized for therapy services
- Patient's private documents are uploaded to the Homecare Home Base system for management/ therapist and authorization team to review the correct home health services needed per the patient's needs
- Assessed information gleaned from interviews, educational and medical records, consultation with other professionals, and diagnostic evaluations to identify clients' abilities, needs, and eligibility for services.
Payment Posting
Medical Practice Solution -MPS
Richardson, TX
12.2017 - 01.2019
- Established questionable for incomplete EOB calling insurance companies for more verification.
- Postings payer remits (paper and electronic) and applies required contractual adjustments accordingly. Posting insurance recoupment by following MPS protocols and documentation of accounts
- Researching complex issues utilizing internal and external resources and contacts
- Responsible to participate in operational and system training, as well as, process improvement implementation., Verified insurance eligibility on primary and secondary insurances, Verified eligibility through
- Workers' Compensation and Compensable injury, Accessed intranet computer Service using Centricity Software.
Account Rep II /Payment Posting , Data Dept
Baylor /HTPN
Plano, TX
12.2015 - 09.2017
- Coding health care claims to obtain reimbursement from insurance companies and government such as Medicare & Commercial insurance healthcare programs
- Manually posting clinic charges and payments from clinic super-bill /posting payment keys strokes 90000
- Printing out mapping reports also with all end-of-day batches showing verification of positive batch balances.
- Worked within applicable standards, policies, and regulatory guidelines to promote safe working environments
- Exceeded goals through effective task prioritization and great work ethic
Account Rep II/ Billing Dept
Concentra Urgent Care
Dallas, TX
09.2009 - 01.2014
- Maintaining and updating patients' addresses on accounts past due, also accepting patients' payments by phone. Managed over 50 customer calls per day.
- Accounts to collection due to nonpayment, mailing pts collection letters, working excel spreadsheets
- Performed verification of medical benefits from commercial insurance companies medicare, obtaining authorization for scheduled procedures
- Accomplished documenting notes in Ge Centricity System posting explanation of benefits & zero pays to account. Transferring pts payments to balance accounts.
- Processed client payments and updated accounts
Medical Billing Coordinator
Kids care Therapy
Dallas, TX
01.2008 - 09.2009
- Billed Medicaid for patients (kids) through systems Homecare Home base Server For services provided (Speech,
- Physical and Occupational Therapy), Billing procedures included using multiple CPT Codes/Modifiers/Rev Codes/ Occurrence Codes & Evaluation codes
- Billing forms included Institutional (UBO4), & Professional (HCFA-1500) also billed electronically through Avidity (Clearance house).
- Communicated with insurance providers to resolve denied claims and resubmitted
Account Information
Pinnacle Anesthesia
Dallas , TX
01.2007 - 12.2008
- Specialist Verified insurance eligibility on primary and secondary insurances, Verified eligibility through Workers' Compensation and the Compensable injury.
- Accessed the intranet computer Service using Centricity Software.
Accounts Payable /Front Office Personnel
CHARITY HOSPITAL
New Orleans, Louisiana
02.2000 - 08.2006
- Receiving copayments from patients for office visits, scheduling patients appointments, filing creating medical charts, daily typing 10-key customer services, customer service explaining patients' EOB and issues with accounts, answering phones, copying and faxing
- Reconcile explanation of benefits daily for all departments, verifying medical benefits, obtaining authorization for scheduled surgery procedures, and documenting notes in Medi-soft system.
- Providing account analyst, account receivable, and auditing skills for all billing departments.
Education
Bachelor of Science - Health Administration
University of Phoenix
Dallas TX09.2018
Associate of Arts And Sciences - Health Administration
University of Phoenix
Dallas Tx 07.2016
Certified Medical Billing Specialist - undefined
Tech skills
2008
High School Diploma -
Francis T .Nicholls
New Orleans, LA05.1995
Skills
- Typing 55 Wpm, 10-key,
- Ge Centricity, Medisoft, Lotus Notes, MS Office & Outlook, Practice Velocity (PV),
- Home Care Home base,
- Epic, Revenue Cycle,
- Billing and collection procedures,
- Excellent verbal communication
- Resourceful and reliable worker
- Medical terminology, Records Management,
- Observation Communication
- ElderCare
- Critical Thinking
- Performance Assessment
Languages
English
Full Professional
Timeline
Medical Billing Skilled Home Health /Liaison
Elara Caring, Dba Jordan Health Care
04.2020 - Current
Medical Billing Specialist Private Duty /Self Pay
Elara Caring, dba Jordan Health Care
05.2019 - 04.2020
Authorization Specialist
Elara Caring dba Jordan Health Care
03.2019 - 05.2019
Payment Posting
Medical Practice Solution -MPS
12.2017 - 01.2019
Account Rep II /Payment Posting , Data Dept
Baylor /HTPN
12.2015 - 09.2017
Account Rep II/ Billing Dept
Concentra Urgent Care
09.2009 - 01.2014
Medical Billing Coordinator
Kids care Therapy
01.2008 - 09.2009
Account Information
Pinnacle Anesthesia
01.2007 - 12.2008
Accounts Payable /Front Office Personnel
CHARITY HOSPITAL
02.2000 - 08.2006
Bachelor of Science - Health Administration
University of Phoenix
Associate of Arts And Sciences - Health Administration
University of Phoenix
Certified Medical Billing Specialist - undefined
Tech skills
High School Diploma -
Francis T .Nicholls
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