Jose Montoya
Summary
Patient Access & Revenue Cycle Specialist with 4+ years of experience in ER/EMS, ambulatory, and office settings. Experienced in Epic Hyperspace/Resolute, insurance verification, EOB interpretation, and claim resolution. Recognized for reducing AR delays while providing clear, compassionate support to patients and families. Bilingual English/Spanish.
Overview
5
5
years of professional experience
Work History
Reimbursement Specialist
Kabafusion
Cerritos, United States
08.2025 - Current
- Managed insurance reimbursement for specialty infusion therapies by verifying benefits, obtaining prior authorizations, and submitting claims to ensure timely payments.
- Obtain and track prior authorizations in accordance with payer requirements.
- Analyze explanation of benefits (EOBs) to identify underpayments or denials.
- Performed monthly audits to verify accuracy of claims submitted, identifying discrepancies to minimize payment delays.
- Full account renconciliation
- Use payment portals such as CPR Plus and Availity to submit patient payments.
- Collected payments, processed receipts and informed policyholders of outstanding balances.
- Precisely calculated refunds, premiums, and adjustments.
- Patient Eligibility for insurance
Patient Representative
UCI Health
08.2024 - 01.2025
- Scheduled and coordinated over 100+ patient appointments weekly across multiple gastroenterology providers with strict adherence to departmental workflows.
- Processed prior authorizations from insurance companies for medical treatments or procedures.
- Resolved patient complaints and issues promptly, ensuring patient satisfaction and adherence to service standards.
- Utilized Epic to manage appointment scheduling, flag urgent referrals, and maintain compliance with billing and medical record standards.
- Demonstrated strong multitasking and time management skills in a fast-paced clinical setting.
- Collected patient payments and reconciled accounts receivable, contributing to accurate financial reporting and revenue management.
Medical Biller and Coder
PIH Health
Whittier, United States
12.2023 - 06.2024
- Oversaw claims for emergency department services from charge entry to denial resolution using Epic Resolute.
- Performed investigations on rejected or underpaid claims, examining error analysis and submitting timely appeals with documentation and corrected ICD-10/CPT codes.
- Audited accounts for accuracy and compliance with payer-specific rules, enhancing revenue integrity and minimizing claim rework.
- Maintained up-to-date CPT, HCPCS, ICD-9, and ICD-10 CM codes libraries to support accurate billing.
- Contributed to department KPIs by maintaining a high claim resolution rate and reducing average days in AR.
- Responded promptly to insurance company requests for clarification on claim submissions, facilitating timely resolution.
- Performed daily audits on all bills submitted for accuracy and completeness.
- Patient eligibility and account reconciliation.
Medical Biller and Coder
AHMC Whittier Hospital
Whittier, United States
05.2021 - 11.2023
- Interpreted EOBs and remittance advice to identify trends in payer rejections and proactively corrected claim errors prior to resubmission.
- Researched rejected claims resulting from incorrect coding or inaccurate information, leading to improved claim accuracy.
- Used Epic Hyperspace and Chartmaxx to review documentation, extract billable procedures, and apply correct modifiers for ER and ambulance services.
- Collaborated with healthcare providers to resolve discrepancies in charges, enhancing billing accuracy.
- Monitored accounts receivable reports to identify outstanding payments and facilitate timely follow-ups.
- Analyzed accounts receivable aging reports daily to ensure timely collection.
- Partnered with internal audit teams to verify documentation accuracy and reduce billing compliance risk.
- Spearheaded bilingual communication efforts for Spanish-speaking patients, improving patient financial understanding and satisfaction.
Education
Associate Degree - Health Administration
Cerritos College
Norwalk12-2026
High School Diploma -
California High School
Whittier01-2018
Skills
- Fluent in English and Spanish
- Epic Hyperspace and Resolute
- ChartMaxx proficiency
- MedAssets expertise
- CPR Plus knowledge
- Denials and appeals management
- ICD/CPT coding
- HCPCS coding
- Insurance reimbursement strategies
- Appeals handling techniques
- Numerical proficiency
- Multitasking skills
- MacOS and Windows OS familiarity
- Typing speed: 55 WPM
- Reading speed: 350 WPM
Personal Information
Timeline
Reimbursement Specialist
Kabafusion
08.2025 - Current
Patient Representative
UCI Health
08.2024 - 01.2025
Medical Biller and Coder
PIH Health
12.2023 - 06.2024
Medical Biller and Coder
AHMC Whittier Hospital
05.2021 - 11.2023
High School Diploma -
California High School
Associate Degree - Health Administration
Cerritos College