JESSICA LIERA
Panorama City
Summary
Results-driven individual with a solid track record in delivering quality work. Known for excellent communication and teamwork abilities, with a commitment to achieving company goals and delivering exceptional service. Passionate about continuous learning and professional development.
Overview
24
24
years of professional experience
Work History
ACCUMULATOR RESEARCHER ADJUSTER
HEALTH NET, INC.
04.2019 - Current
- Conduct research and compile members' Out-of-Pocket Maximum (OOPM) audits for all products associated with ABS and Amisys.
- Make sure all members are reimbursed from all vendors if there is any excess totaling 100 members monthly.
- Research and create members OOPM audits for all the products under ABS and Amis.
- Coordinate with various vendors to facilitate timely reimbursements for members' coverage from Pharmacy, MHN, ASH, or PPG.
- Follow up with multiple vendors to assist the member in getting reimbursed for overages due to them from Pharmacy, MHN, ASH or PPG.
- Provide OOPM Max Met spreadsheet to member and providers.
- Work on priority projects and meet deadlines.
- Identify and address trends effectively and efficiently.
- Verify member eligibility and plans under ABS and Amisys.
- Request Moop/Copay reports from medical groups to ensure all claims are accounted for in the audit.
- Obtain Explanation of Benefits (EOBs) or proof of reimbursement from the PPG for the member.
- Prioritize projects and ensure adherence to deadlines.
ANALYSIS RESEARCH REPRESENTATIVE COLLECTOR
IPC HEALTHCARE INC.
05.2015 - 03.2019
- Responsible for identifying trends, submitting filed appeals, rebilling reprocessed outstanding unpaid claims, verifying confirmed patient eligibility, making proper corrections to secure payments.
- Conducted calls as needed to obtain proper accurate patient information for accounts with large balances.
- Followed-up on cases by generating monthly accounts receivable reports (AR), Analyzer, and Case Rates/Fee-for-Service reports.
COMPLIANCE PROJECT SPECIALIST
IPC HEALTHCARE INC.
01.2014 - 04.2015
- Reviewed and researched EOB’s from various insurance companies to ensure reimbursement was received.
- Processed refunds when applicable to the correct insurance company/patient.
- Verified eligibility to ensure patient is up to date with coverage.
INSURANCE BILLER
CERF DIAGNOSTIC INC.
04.2013 - 11.2013
- Performed insurance/medical verification for private insurance and medical patients, and reviewed EOB’s from various insurance companies.
- Processed claims, posted payments/adjustments, and reviewed denials from medical insurances.
- Made necessary corrections to ensure reimbursements were properly given to the insurance or medical patients.
- Performed office duties like answering phone calls, submitting faxes, and alphabetizing files to support daily operations.
HEAD CASHIER/RECEPTIONIST
VAN NUYS CDJR DEALERSHIP
04.2012 - 03.2013
- Answered multi-line phone systems, transferring calls and providing a positive customer service experience.
- Maintained and organized records and files.
- Processed credit card, check, and cash transactions accurately and effectively.
MEDICAL/INSURANCE BILLER
PATHNET ESOTERIC LABORATORY
04.2001 - 02.2009
- Processed claims and performed insurance/medical verification for private insurance and medical patients.
- Assisted patients in understanding their medical benefits, specifically regarding their insurance coverage, deductible and co-insurance payments.
- Reviewed EOB’s from various insurance companies, processed medical denials, and made necessary corrections to ensure timely reimbursement.
- Tracked and followed up on outstanding claims by working on aging reports.
- Conducted follow-up calls or sent written correspondences to payer and/or patients to optimize and expedite reimbursement.
- Posted payments/adjustments and conducted electronic billing/HCFA 1500 claims.
Education
Certificate - MEDICAL BILLING/HEALTH CLAIMS EXAMINER
ADELANTE CAREER INSTITUTE
06.2000
Skills
- OOPM auditing
- Judgment and decision-making
- Planning and organization
- Patient-centered care
- HIPAA compliance
- Microsoft Word and Excel
- Customer service excellence
- Bilingual communication (English/Spanish)
- ICD-9 and CPT coding
- HCFA 1500 processing
- Electronic billing systems
- Data analysis techniques
- Auditing standards
- Decision-making strategies
- Research ethics compliance
- Proposal development
- Problem-solving skills
- Trend analysis
- Medical billing processes
- Vendor management
- Effective communication skills
- Attention to detail
- Departmental reimbursement strategies
- Project prioritization techniques
- effective multitasking abilities
Timeline
ACCUMULATOR RESEARCHER ADJUSTER
HEALTH NET, INC.
04.2019 - Current
ANALYSIS RESEARCH REPRESENTATIVE COLLECTOR
IPC HEALTHCARE INC.
05.2015 - 03.2019
COMPLIANCE PROJECT SPECIALIST
IPC HEALTHCARE INC.
01.2014 - 04.2015
INSURANCE BILLER
CERF DIAGNOSTIC INC.
04.2013 - 11.2013
HEAD CASHIER/RECEPTIONIST
VAN NUYS CDJR DEALERSHIP
04.2012 - 03.2013
MEDICAL/INSURANCE BILLER
PATHNET ESOTERIC LABORATORY
04.2001 - 02.2009
Certificate - MEDICAL BILLING/HEALTH CLAIMS EXAMINER
ADELANTE CAREER INSTITUTE
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