Karem Adame Soto
Fort Worth,Tx
Summary
I have developed a unique perspective on business and public relations. Seeking an opportunity where my skills and experience can be of value. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Medical Billing and Collections Specialist
Fort Worth Heart
Fort Worth, TX
02.2024 - Current
- Verified patient insurance eligibility and coverage for medical services rendered.
- Reviewed, coded, and submitted claims to insurance companies and government payers.
- Followed up on unpaid or denied claims in a timely manner.
- Resolved billing discrepancies with insurance companies and patients.
- Communicated with patients regarding payment plans, overdue balances, and collections issues.
- Maintained detailed records of all billing activities in compliance with company policies and procedures.
- Processed credit card payments from patients for medical services rendered.
- Responded promptly to customer inquiries regarding billing disputes or discrepancies.
- Entered patient charges and payments into electronic health records.
- Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
- Submitted claims to insurance companies.
Case Manager
Rmex Mckesson
Fort Worth, TX
10.2023 - 02.2024
- Prior- Authorization and insurance Verification
- Communicate with patients, provider & insurance payers via telephone & email
- Verify Patients insurance coverage
- Billing and Coding
- Receive Inbound and outbound calls from patients and insurance providers
Marketing Call Center Representative
Cornerstone Staffing - Cook Children's Health Plan
Fort Worth, Tx
04.2023 - 09.2023
- Managing large amounts of inbound and outbound calls in a timely manner
- Certified to schedule and assist members with navigating through the Texas health and human services websites/forms to apply for Medicaid/chip benefits
- Followed company policies and scripts to ensure that call-time and quality standards were met on a consistent basis
- Collaborate with other call center/Marketing team professionals to improve issues, data entry and create strategies to help members renew their health care benefits.
Patient Access Specialist
JPS Health Network
Fort Worth, TX
03.2023 - 04.2023
- Responded to patient concerns and inquiries professionally and efficiently.
- Verified demographics and insurance information to register patients in computer system.
- Scheduled and confirmed appointments.
- Provided delay updates and information regarding special circumstances.
Patient Account Representative
Cook Children's Home Health
Fort Worth, Tx
03.2022 - 01.2023
- Resolved potential delays and trends with payors through corrective actions to avoid AR aging
- Resolved account issues via communications with employers, insurance companies
- Followed up on denied claims by performing appeals and denial recovery procedures
- Managed work queue, aging lists and claims correspondence for accurate and timely payment
- Verified billing data completeness and accuracy and revised errors
- Managed coding and abstracting of inpatient and outpatient medical records
- Analyzed claims data to verify assigned codes, signatures, and authorizations
- Observed and enforced all ICD-10-CM coding rules and regulations.
Patient Registration Representative
Cornerstone Staffing, Cook Children's Home Health
Fort Worth, Tx
10.2021 - 03.2022
- Answered phone calls to help customers with their questions and concerns over order
- Aided patients in completing check in and payment forms
- Reviewed and corrected insurance claim errors to ensure smooth processing
- Explain treatment plans and payment options to patients depending on order
- Solved order issues, improved operations, and provided excellent customer service
- Collaborated with customers to determine their needs and deliver options for their DME order
- Oversaw compiling and reviewing medical records.
Medical Record Clerk
Southwest Nursing and Rehab Center
Fort Worth, Tx
06.2018 - 01.2021
- Obtained necessary signatures on information release forms to obtain medical and treatment records from other service providers
- Maintained patient records in compliance with security regulations
- Maintained patient confidence by keeping patient records information confidential
- Reviewed medical records for completeness and file records in alphabetic and numeric order.
Activities Assistant
Southwest Nursing and Rehab Center
Fort Worth, Tx
06.2018 - 01.2020
- Helps residents engage in relationships and build social connections with a robust activities calendar
- Maintained residents mental acuity and manual dexterity with activities such as arts and crafts
- Engaged less mobile residents in one-on-one activities like personal visits and musical entertainment.
Education
Certified Billing and Coding Specialist -
North Texas Institute
08.2021
High School Diploma -
South Hills High
06.2015
Skills
- Bilingual in Spanish
- Customer Service
- Medical Coding
- Medical Records
- Verification Insurance
- Authorizations
- Data Entry
- Microsoft Office
- Epic
- AthenaHealth
Certification
- Certified Billing and Coding Specialist (CBCS)
Timeline
Medical Billing and Collections Specialist
Fort Worth Heart
02.2024 - Current
Case Manager
Rmex Mckesson
10.2023 - 02.2024
Marketing Call Center Representative
Cornerstone Staffing - Cook Children's Health Plan
04.2023 - 09.2023
Patient Access Specialist
JPS Health Network
03.2023 - 04.2023
Patient Account Representative
Cook Children's Home Health
03.2022 - 01.2023
Patient Registration Representative
Cornerstone Staffing, Cook Children's Home Health
10.2021 - 03.2022
Medical Record Clerk
Southwest Nursing and Rehab Center
06.2018 - 01.2021
Activities Assistant
Southwest Nursing and Rehab Center
06.2018 - 01.2020
Certified Billing and Coding Specialist -
North Texas Institute
High School Diploma -
South Hills High
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