Jessica S. Prieto
Edinburg,Texas
Summary
Accomplished Billing Specialist offering well-honed account management experience. Leverages excellent organizational and problem-solving skills to maintain billing and increase account collections. Skilled in maintaining precise records and building relationships with clients.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Hospital Biller
Ricardo Abreu MD PA
McAllen , TX
2024.03 - Current
- Prepared detailed claims for submission to insurance companies according to policy guidelines.
- Analyzed patient accounts for errors or discrepancies in order to resolve issues quickly.
- Provided customer service support by responding promptly to inquiries from patients regarding their bills.
- Reviewed and verified accuracy of patient insurance information and billing documents.
- Performed daily follow-up on outstanding claims to ensure prompt payment from payers.
- Participated in training sessions related to new policies and procedures as well as updates on existing ones.
- Coded invoices properly based upon patient services and medical records.
- Submitted claims to insurance companies.
Front Staff Coordinator/Office Medical Biller
Argenal Pediatrics
Edinburg , TX
2021.03 - 2023.07
- Organized and maintained staff calendars and schedules, ensuring all deadlines were met.
- Monitored project progress and performance, providing feedback when necessary.
- Resolved conflicts between staff members regarding workflow issues or customer service matters.
- Collaborated with other departments to develop strategies that improve organizational effectiveness.
- Managed recruitment process including screening applicants, scheduling interviews, conducting reference checks.
- Served as a liaison between upper management and staff members by communicating expectations and providing guidance as needed.
- Issued work schedules, duty assignments and deadlines for office or administrative staff.
- Resolved discrepancies between insurance payments and billed amounts by contacting insurers regarding unpaid claims.
- Verified that all information on the claim was accurate before submitting it for payment.
- Reviewed patient bills for accuracy and completeness, ensuring all charges are accurate and appropriate.
- Submitted appeals as needed when a claim was not paid in full or denied by an insurer.
- Managed accounts receivable, including aging reports, denials management, collections activities, cash applications.
Office Medical Biller
Pediatric Heart Clinic
Edinburg , TX
2019.08 - 2020.04
- Reviewed patient bills for accuracy and completeness, ensuring all charges are accurate and appropriate.
- Processed medical insurance claims electronically and manually to ensure timely payment from insurance companies.
- Identified any denied or rejected claims and worked with providers to resolve them.
- Verified that all information on the claim was accurate before submitting it for payment.
- Submitted appeals as needed when a claim was not paid in full or denied by an insurer.
- Updated patient records with new insurance information when necessary.
- Complied with HIPAA guidelines while handling confidential patient information.
- Developed strong working relationships with third-party payers to facilitate prompt resolution of claims disputes.
- Provided assistance with other administrative duties within the office such as filing paperwork or scheduling appointments.
- Assigned CPT procedure and evaluation and management (E&M) codes for services to assure appropriate billing and reimbursement.
- Added modifiers, coded narrative diagnosis and verified diagnoses.
- Performed with precision by entering data accurately and researching to resolve questions.
Medical Biller
Ashley Pediatrics Day and Night Clinic
Edinburg , TX
2015.12 - 2019.07
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Maintained up-to-date knowledge of government regulations related to healthcare reimbursement policies and procedures.
- Generated reports in order to track payments due from insurance companies or other third party payers.
- Submitted electronic claims to various insurance carriers.
- Answered incoming calls regarding billing inquiries from patients and and or providers in a professional manner.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Collaborated with managers to develop strategies for improving revenue cycle processes.
- Prepared detailed financial reports as requested by management team.
- Processed refunds requests timely and accurately according to established protocols.
- Completed and submitted appeals for denied claims.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
Medical Biller
Divine Childrens Clinic
Donna , TX
2015.07 - 2015.12
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Compiled and processed data for billing purposes utilizing billing software programs.
- Submitted electronic claims to various insurance carriers.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Assisted in auditing process by verifying accuracy of submitted claim forms against documentation provided by physicians' offices.
- Completed and submitted appeals for denied claims.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
Medical BIller
Guajira Family Clinic and Diabetes Care
McAllen , TX
2014.06 - 2015.07
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Submitted electronic claims to various insurance carriers.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Performed follow up activities on unpaid claims with insurance companies or other third party payers by phone or written correspondence.
- Created monthly aging reports to identify delinquent accounts for review by management team.
- Ensured compliance with HIPAA guidelines when handling confidential patient information.
- Completed and submitted appeals for denied claims.
- Applied HIPAA privacy and security regulations while handling patient information.
- Submitted appeals using provider portals and phone communication.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
Medical Biller
Donna Medical Clinic
Donna , TX
2009.04 - 2010.11
- Compiled and processed data for billing purposes utilizing billing software programs.
- Submitted electronic claims to various insurance carriers.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Answered incoming calls regarding billing inquiries from patients and and or providers in a professional manner.
- Completed and submitted appeals for denied claims.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
Medical Biller
Optimized Medical Billing
McAllen , TX
2005.06 - 2009.04
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Submitted electronic claims to various insurance carriers.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Performed daily reconciliation of accounts receivable with payment postings on the computer system.
- Performed follow up activities on unpaid claims with insurance companies or other third party payers by phone or written correspondence.
- Created monthly aging reports to identify delinquent accounts for review by management team.
- Maintained accurate records of all billing activity in accordance with departmental standards.
- Assisted in auditing process by verifying accuracy of submitted claim forms against documentation provided by physicians' offices.
- Processed refunds requests timely and accurately according to established protocols.
- Completed and submitted appeals for denied claims.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
Education
Associate of Applied Science - Health And Medical Administrative Services
CHCP of Mcallen
McAllen, TX2024-05
MOS Certificate - Medica Office Specialist
SACMDA
McAllen, TX2003-01
GED -
STCC
McAllen, TX2000-06
Skills
- Funds allocation
- Regulatory Compliance
- Conflict Management
- Patient information management
- Deadline-driven
- Posting charges
- Insurance billing procedures
- HIPAA Compliance
- Office Administration
- Scheduling
- Employee Supervision
- Administrative Management
- Teamwork and Collaboration
- Documentation and Recordkeeping
- Schedule Management
- Problem-Solving
- Attention to Detail
- Multitasking
- Excellent Communication
- Interpersonal Communication
Certification
- Medical Office Compliance Certificate
- Medical Office Specialist Certificate
- HIPPA Certified
Languages
Spanish
Professional
English
Professional
References
References available upon request.
Timeline
Hospital Biller
Ricardo Abreu MD PA
2024.03 - Current
Front Staff Coordinator/Office Medical Biller
Argenal Pediatrics
2021.03 - 2023.07
Office Medical Biller
Pediatric Heart Clinic
2019.08 - 2020.04
Medical Biller
Ashley Pediatrics Day and Night Clinic
2015.12 - 2019.07
Medical Biller
Divine Childrens Clinic
2015.07 - 2015.12
Medical BIller
Guajira Family Clinic and Diabetes Care
2014.06 - 2015.07
Medical Biller
Donna Medical Clinic
2009.04 - 2010.11
Medical Biller
Optimized Medical Billing
2005.06 - 2009.04
- Medical Office Compliance Certificate
- Medical Office Specialist Certificate
- HIPPA Certified
Associate of Applied Science - Health And Medical Administrative Services
CHCP of Mcallen
MOS Certificate - Medica Office Specialist
SACMDA
GED -
STCC
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