Juanita Ramos
Summary
I am focused on business efficiency and operational improvements. I have a strategic and forward-thinking mindset. I Bring a willingness to learn and adaptability to changing circumstances. I am committed to providing quality work while being compassionate towards our patients.
Overview
17
17
years of professional experience
Work History
Project Supervisor-Patient Financial Services
Guidehouse
San Marcos, CA
03.2024 - Current
- Responsible for customer service issues for members, families, providers and potential clients for medical billing and claims processing, including payment, coordination or subrogation of benefits.
- Sets employee performance objectives, conducts performance reviews, may make recommendations on pay actions and other personnel actions.
- Incorporates significant improvements to guidelines and processes that have mid- to long-term impact on result.
- Establishes key elements of operational plans with measurable contribution towards the achievement of operational targets.
- Sets priorities for the team to ensure task completion; coordinates work activities with other supervisors or managers.
Reimbursement Specialist
Palomar Health
Escondido, CA
04.2021 - Current
- Submit claims to insurance companies.
- Answered customer questions to maintain high satisfaction levels.
- Performed insurance verification, pre-certification and pre-authorization.
- Identify follow up problems and issues.
- Check status of claims
- Follow-up of claims to Medicare, Medi-Cal, Commercial, HMO, PPO, Managed Care, and other third party payers and guarantors.
- Analyze contractual arrangements as determined by contractual agreements.
- Reviews remittance codes from EOB ensure appropriate payment or to identify denials or non-payment.
- Responsible for complete, accurate, and timely documentation of all follow-up pertaining to the resolution of the account within the current hospital information systems
Patient Financial Services Supervisor
Palomar Health
Escondido, CA
07.2022 - 10.2023
- Developed strategies to improve patient financial services processes and procedures.
- Monitored accounts receivable aging report on a regular basis and took corrective action when necessary.
- Worked closely with the billing department staff to ensure that all bills were paid promptly and accurately according to contractual agreements with payers.
- Performed research into complex billing issues involving multiple payers or providers.
- Analyzed data from various sources in order to identify denial trends and payer issues.
- Ensured compliance with federal, state, local laws governing healthcare reimbursement practices.
- Review, Edit, and Approve timecards.
- Train and educate new and seasoned staff.
- Interact and collaborate frequently with staff and leadership of the revenue cycle teams throughout the organization.
- Frequent interaction with system vendors as well as outsourced agencies and third party payer groups.
- Provide training and competency evaluation of team members as it relates to specific job functions and responsibilities.
- Conduct Quality Reviews for each Direct Report on a monthly basis.
- Manage Direct Report's Productivity.
- Ensure Implementation of HIPAA Standards
- Conduct Team Meetings Weekly.
- Conduct Vendor Meetings Bi-Weekly
Admin Partner
Palomar Health
Escondido, CA
07.2020 - 04.2021
- Documented and managed patient information in computer system.
- Answered patient questions and fielded complaints to resolve issues.
- Coordinated with patients and healthcare professionals to meet patient needs.
- Scheduled and confirmed patient appointments with patients and healthcare professionals.
- Accessed patient information through various software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
- Facilitated communication between patients, medical and administrative staff, administrative staff..
- Explained policies, procedures and services to patients.
- Ensure Referrals were signed within 30 days of care.
Medical Billing Specialist
Acadia Healthcare
Carlsbad, CA
01.2019 - 07.2020
- Verified patient health Insurance Benefits and Eligibility
- Request and Track Pre-Certifications for services.
- Quote Patient's financial risk.
- Submit Demographics and Claim information.
- Bill Claims and Follow-up on status.
- Generate Weekly and Monthly reports.
- Post payments.
- Adjust claims according to contracts.
- Review patient Refunds.
- Assist Timely submission of credentialing documentations.
- Stay informed of Medicare and Medicaid Changes.
- Took billing calls, questions and concerns from patients and third party carriers, and Providers.
- Identified discrepancies and carrier issues regarding billing and reimbursements.
- Interact frequently with staff, leadership of the revenue cycle teams, including but not limited to Patient Access, REvenue Cycle, Health information Services, Utilization Management/Case management, charge Capture, contract Management, Credentialing Management, and Information Technology Services.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Work with leadership to eliminate issues and formulate plans for resolution.
Medical Billing and Collections Specialist
Critical Care Specialty Billing
Carlsbad, CA
01.2017 - 01.2019
- Provided Support services to staff. (Cash Posting department, administrative back-up, Credentialing Department.)
- Took billing calls, questions and concerns from patients,third party carriers, and providers.
- Identified discrepancies and carrier issues regarding billing and reimbursements.
- Processed refund requests and reconciled deposit and patient collections.
- Corrected, completed and processed claims for payer codes.
- Entered patient charges and payments into electronic health records.
- Entered encounter information and charges in billing software to generate claim.
- Answered customer questions to maintain high satisfaction levels.
- Executed account updates and noted account information in company data systems.
- Processed invoice payments and recorded information in account database.
- Eliminated inaccuracies in accounts payable payments by verifying information prior to generating checks and electronic payment transfers.
- Submitted claims to insurance companies.
- Managed Patient accounts.
- Managed payments processing, invoicing and collections tasks .
- Monitored past due accounts and pursued collections on outstanding invoices.
- Work with Patients and set up Payment plans.
- Meet with Contracted Providers to discuss billing issues, Cash collections, and regulatory updates.
- Work with leadership to eliminate issues and formulate plans for resolution.
Accounts Receivable Specialist
Eternal Hills Funeral Home
Oceanside, CA
04.2008 - 10.2014
- Verified, classified, computed, posted and recorded accounts payable data and reconciled daily totals to confirm proper accounting.
- Interfaced with customers to bring accounts current with suitable repayment plans.
- Managed invoicing for organization through cash receipts processing, bank reconciliations,
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Generated, mailed and monitored invoices.
- Performed various accounts receivable functions, handled cash receipts posting, updated cash flow reports and researched chargebacks and write-offs.
- Performed administrative tasks to support strategic initiatives.
- Train and Support Administrative Staff
- Process Quit Claims
- Audit Contracts, Cash Journals, and Receipt Books.
- Generated and provided data validation and quality assurance of all monthly Accounts Receivable reports.
Education
Associate of Arts - Liberal Arts, Medical Office Professional
Mira Costa Community College
OceansideSkills
- Accounts Payable and Receivable
- Work Planning and Prioritization
- Administration and Reporting
- Microsoft Office
- Internal and External Customer Service
- Verbal and Written Communication
- Root Cause Analysis
- Operate Standard Office Equipment
- Team Building
- Critical Thinking
- Recruitment and Hiring
- Conflict Resolution
- Organizational Skills
- Billing Dispute Resolution
- Training and Teaching
- Clerical Support
- Insurance Collections
- Proficiency in Cerner
- Financial Services
- Leadership
Additional Information
- Certified Professional Biller - AAPC, October 2022
- Certified Revenue Cycle Representative- HFMA, January 2024
Languages
Spanish
Professional
Timeline
Project Supervisor-Patient Financial Services
Guidehouse
03.2024 - Current
Patient Financial Services Supervisor
Palomar Health
07.2022 - 10.2023
Reimbursement Specialist
Palomar Health
04.2021 - Current
Admin Partner
Palomar Health
07.2020 - 04.2021
Medical Billing Specialist
Acadia Healthcare
01.2019 - 07.2020
Medical Billing and Collections Specialist
Critical Care Specialty Billing
01.2017 - 01.2019
Accounts Receivable Specialist
Eternal Hills Funeral Home
04.2008 - 10.2014
Associate of Arts - Liberal Arts, Medical Office Professional
Mira Costa Community College