JANET A SANTIAGO
CARLSBAD
Summary
Medical billing and collections professional with proven track record in handling complex billing systems and resolving claims efficiently. Known for strong teamwork and ability to adapt to changing priorities. Skilled in patient account management and regulatory compliance, consistently ensuring accurate and timely billing.
Overview
21
21
years of professional experience
Work History
Medical Billing and Collections Specialist
Skin Surgery Medical Group
02.2020 - 07.2024
- Reduced claim denials by diligently reviewing patient records for correct coding and billing information.
- Prevented unnecessary loss of revenue due to late or incomplete billing by meticulously tracking all accounts and ensuring timely submission of accurate claim forms.
- Provided essential support to the medical billing team, allowing for a more efficient and effective overall operation within the department.
- Maintained excellent relationships with insurance representatives to expedite claims processing and secure timely reimbursements for services rendered.
- Improved cash flow through timely follow-up on outstanding accounts, negotiating payment plans, and collecting overdue payments.
Medical Billing and Collections Specialist
Nexus Healthcare Solutions
05.2019 - 08.2019
- EMS billing and follow-up to decrease outstanding balances
- Appeals which brought in revenue
- Collection write off
- Insurance and Patient calls
- Training other team members on billing software
- Skilled at working independently and collaboratively in a team environment.
Medical Billing Specialist
Critical Care Specialty Billing
09.2013 - 05.2018
- Ambulance billing for 6 different clients
- Downloaded and entered charges to get them ready for billing
- Ensured claims were entered and submitted within 48 hours of receipt
- Accurately apply payments to patient accounts
- Research and resolve incorrect payments, EOB rejections and other issues with outstanding accounts
- Insure accuracy of insurance claims
- Verified correct ICD-9 and CPT codes and that claim was being sent to the correct address
- Retrieve Electronic Remittance Advice (ERA's)
- Send secondary claims upon processing of primary insurance
- Monthly processing of Patient Statements
- Answer and resolve patient billing inquiries
- Follow up on insurance and patient aging
- Resubmit insurance claims as necessary
- Knowledgeable in timely filing restrictions
- Insure office practices are in compliance with HIPPA regulations
- Processed both patient and insurance refunds in a timely manner
- Worked collections which included mailing of correspondence, working with patients to establish promissory notes for payment and if necessary forwarded accounts to collection agency Maintained highest levels of accurate and patient confidentiality
Medical Billing Specialist
Abeo Management
03.2011 - 11.2012
- Worked billing and collection accounts for Anesthesia Medical Group; primarily responsible for workers compensation accounts
- Assisted with collection and billing of other type of payors such as HMO, PPO, Government Insurance and Private Pay
- Familiar with collection stipulations regarding all types of carriers Consistently met and exceeded quota of number of files touched per day and met monthly collection goals
- Worked claims aged within 30-45 days keeping aging as low as possible
Medical Billing Specialist
Physician Health Services
09.2003 - 11.2008
- Efficiently handled full cycle billing and collection process of medical claims for different payors including government agencies, HMO, PPO and private pay
- Reviewed rejected insurance claims and provided insurance carriers with corrected information in a timely manner to get claim processed and paid
- Provided tenacious follow-up to ensure proper payments were fully collected on within 30-45 days
- Completed data entry and coding of orthopedic charges
- Worked on monthly A/R and collected for 3 urgent care clinics, consistently meeting and exceeding collection goals
- Worked patient accounts and provided the best customer service until patient fully understood what they were being billed for
- Researched and appealed denied claims interacting daily with the insurance carriers
Education
High School Diploma -
Carlsbad High
Medical Billing Specialist -
Comprehensive Training Systems
01.2003
Skills
- Denial resolution
- Payment posting
- Medical billing software proficiency
- Claim submission
- Patient billing
- HIPAA compliance
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Medical Billing and Collections Specialist
Skin Surgery Medical Group
02.2020 - 07.2024
Medical Billing and Collections Specialist
Nexus Healthcare Solutions
05.2019 - 08.2019
Medical Billing Specialist
Critical Care Specialty Billing
09.2013 - 05.2018
Medical Billing Specialist
Abeo Management
03.2011 - 11.2012
Medical Billing Specialist
Physician Health Services
09.2003 - 11.2008
Medical Billing Specialist -
Comprehensive Training Systems
High School Diploma -
Carlsbad High
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