Janet Guzman
Bellevue,WA
Summary
Confident Biller with great medical billing skills and more than 9 years of experience. Effective team player known for reliability and quick work. Dedicated to accuracy and efficiency.
Overview
9
9
years of professional experience
Work History
Medical Biller, Accounts Receivable
Fairfax Behavioral Health Hospital
04.2023 - Current
- Participated in ongoing training sessions to stay current on industry best practices for medical billing and coding procedures.
- Verified insurance of patients to determine eligibility.
- Experience billing Facility/ Provider Claims for Carrier such as: Medicare/Medicaid, HMO/ PPO, Tricare/Triwest/VA , County grant Carriers(i.e BH-ASO)
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Reconciled accounts receivable to general ledger.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Delivered timely and accurate charge submissions.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Trained new team members in medical billing software, increasing efficiency within the department.
- Reviewed outstanding balances owed by patients; initiated collection actions if necessary resulting in improved account recovery efforts.
- Maintained up-to-date knowledge of billing software and healthcare regulations, contributing to department's compliance and efficiency.
- Used data entry skills to accurately document and input statements.
Medical Biller/Auditor
Physicians Choice
11.2021 - 03.2023
- Post insurance payments and process daily reports from Urgent Care, ER and Anesthesia billing that are assigned using Laserfiche
- Respond to inquiries from Omega Healthcare regarding payment and denials from EOB
- Auditing their work from posting payments that include questions from their India branch
- Tagging denials for representatives to assist insurance and reprocess claims
- Answer patient calls regarding bill statements
- Working on bulked accounts and aging reports that are past due
- Review remittance and apply to patients or insurance accounts
- Call insurances regarding questions on payment and missing EOBs
- Depositing checks electronically for specific groups
- Call CMRE (Collection Agency) regarding patient payment
- Assist account receivable reps to locate patient’s payment and answer questions on insurance payments
- Audit monthly balance using Qport(software) and AS400(software) for month end postings
- Work for multiple urgent cares, ERs
- Anesthesia, and telehealth groups
- Post all payments accurately to ensure no errors are introduced while posting
Medical Biller
Glendale Internal Medicine And Cardiology
02.2019 - 12.2021
- Filed authorizations verifying patient information
- Posted insurance payments and processed daily reports ensuring that it was balanced
- Submitted claims and reprocessed them when necessary
- Provided administrative support to doctors to assign ICD-10 codes, CPT codes and patient information
- Request and input authorizations for HMOs in Medical Management program
- Called insurance companies to clarify disputes and advocate on behalf of patients
- Received calls from patients and assisted in explaining breakdown of their billing statements
- Called hospitals to request medical records needed for billing purposes
- Completed billing functions such as charge entries, claims payment posting, medical coding and reimbursements
- Reviewed charges for dates of service, services provided, patient identification and provider signature for accuracy and completeness
- Complete monthly aging reports to ensure that all claims are completed
- Registered all necessary payer portals and submit all require verification documents for access
Medical Biller, Accounts Receivable
Transcounty Associates
08.2015 - 07.2019
- Communicated with insurance, through phone and email, to verify eligibility of claims and denials on behalf of patients
- Work alongside management to maintain proper paperwork and documentation
- Filled claims using ICD-10 and CPT codes
- Complete billing functions such as charge entries, claims payment posting, medical coding and reimbursements
- Review charges for dates of service, services provided, patient identification and provider signature for accuracy and completeness
- Complete monthly aging reports to ensure that all claims are completed
Education
Medical Billing and Coding Certification - Medical Billing And Coding
American Career College
Los Angeles, CA08.2015
Skills
- Working knowledge of Medical Terminology: ICD-9, ICD-10/CPT codes, and HCPCS
- Experienced in processing Provider and Facility claims for major and private insurance carriers including: HMO/PPO, Blue Cross/Blue Shield, and Medicaid/Medicare
- Knowledgeable in Billing system as in Lytec, Onstaff, Medical Management, and Office ally software, AS400, Laserfiche, Qport, Banking Electronic check, Waystar, Provider One, Midas
- Typing skills: 40 WPM
- Strong interpersonal and sales skills
- Working knowledge of Microsoft office programs
- Audit Procedures
- Teamwork and Collaboration
- Electronic Claims
- CMS-1500/ UB04 Billing Forms
- Accounts Receivable
- Data Entry
- Filing Appeals
- Invoice Reconciliation
- Claim Processing
- Posting charges
- Dispute Resolution
- Spreadsheet Management
- Financial Management
- Payment posting
- HIPAA Compliance
- Claim submission
- Billing systems and software
- Customer Engagement
- Claims Processing
- Accounts receivable management
- Customer Service
- Multitasking
- Payment Processing
- Medical coding knowledge
- Insurance Verification
- Insurance billing procedures
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Medical Biller, Accounts Receivable
Fairfax Behavioral Health Hospital
04.2023 - Current
Medical Biller/Auditor
Physicians Choice
11.2021 - 03.2023
Medical Biller
Glendale Internal Medicine And Cardiology
02.2019 - 12.2021
Medical Biller, Accounts Receivable
Transcounty Associates
08.2015 - 07.2019
Medical Billing and Coding Certification - Medical Billing And Coding
American Career College
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