Juanita Reyes
Indio,CA
Summary
Accomplished Reimbursement Specialist excelling at Tandem Diabetes Care Inc., adept in claims processing and denial management. Expertise in managing complex billing systems, ensuring compliance, and optimizing revenue recovery. Strong skills in coding, payer relations, and problem-solving within dynamic healthcare environments.
Overview
23
23
years of professional experience
Work History
Reimbursement Specialist
Tandem Diabetes Care Inc.
05.2022 - Current
- Processed reimbursement claims efficiently, ensuring compliance with company policies and payer requirements.
- Reviewed patient documentation for accuracy, facilitating timely approvals and payments.
- Collaborated with healthcare providers to resolve claim discrepancies and enhance communication channels.
- Analyzed reimbursement trends to identify potential issues and recommend process improvements.
- Managed payer correspondence, addressing inquiries and disputes to maintain strong relationships with insurance companies.
- Provided exceptional customer service when responding to patient inquiries about reimbursement status and procedures.
- Supported company objectives by maintaining compliance with all relevant state and federal regulations governing medical billing practices.
- Identified trends in reimbursement denials, recommending process improvements to minimize future occurrences.
- Contributed to increased team productivity by consistently meeting or exceeding individual processing goals.
Medical Biller
Aneta Stirling MD
12.2002 - Current
- Oversaw billing processes, ensuring compliance with healthcare regulations and payer guidelines.
- Implemented efficient coding practices to enhance claim submission accuracy and reduce denials.
- Collaborated with healthcare providers to resolve billing discrepancies and improve patient communication.
- Streamlined workflows by integrating new technologies into the billing process, increasing productivity.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- 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.
- Collected payments and applied to patient accounts.
- Posted payments and collections on regular basis.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Maintained compliance with industry regulations by staying updated on changes to medical billing codes and requirements.
- Established strong relationships with insurance representatives, facilitating prompt resolution of billing issues.
- Reviewed outstanding balances owed by patients; initiated collection actions if necessary resulting in improved account recovery efforts.
- Assisted patients in understanding insurance benefits, leading to a positive experience during their visit.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
Revenue Cycle Specialist
Eisenhower Medical Center
02.2017 - 05.2022
- Analyzed patient accounts to identify discrepancies and ensure accurate billing processes.
- Oversaw revenue cycle operations, implementing process improvements to enhance efficiency and accuracy.
- Collaborated with clinical staff to streamline documentation for timely claims submission and payment resolution.
- Trained and mentored new team members on best practices in revenue cycle management and compliance standards.
- Streamlined the revenue cycle process for improved efficiency and faster payment collection.
Education
High School Diploma -
Falcon High School
Peyton, CO05-1995
Skills
- Appeals handling
- Claims processing
- HIPAA compliance
- ICD-10 coding
- Microsoft office
- Insurance verification
- Denial management
- Bookkeeping
- Payment posting
- Eligibility verification
- Commercial insurance
- Medicare
Timeline
Reimbursement Specialist
Tandem Diabetes Care Inc.
05.2022 - Current
Revenue Cycle Specialist
Eisenhower Medical Center
02.2017 - 05.2022
Medical Biller
Aneta Stirling MD
12.2002 - Current
High School Diploma -
Falcon High School