Karina Salgado
Fullerton,CA
Summary
Detailed-oriented Medical Billing specialist with 5+ years of experience in payment posting and managing medical insurance claims. Outstanding knowledge of reading EOB’s, researching payment discrepancies, understanding insurance contracts.
Overview
11
11
years of professional experience
Work History
Payment Poster
R1 Rcm
Orange, USA
10.2018 - Current
- Accurately post payments which include checks, EFT’s, and credit cards to patient accounts.
- Accurately post denials with reason code from the ERA.
- Reconcile bank statements.
- Recognized and report to superior any consistent trends.
- Responsible for balancing batches assigned to them via Practice management System.
- Collaborate with teammates to ensure that our department month end goal is reached.
- Utilized Insurance websites to obtain EOB’s and research payments.
SHOP Call Center Representative I
Pinnacle Claims Management.
Irvine, USA
11.2015 - 10.2018
- Answered telephone calls and obtain clients' information.
- Fostered and built collaborative working relationships with Health Insurance Agents/Brokers, Qualified Health Plans, federal and state agency contacts and other stakeholders in Covered CA’s Health Benefit Exchange administration.
- Was the subject matter expert for Covered CA and the Health Benefit Exchange benefits, eligibility/enrollment and application processes.
- Input call data into the company database and generated reports for management at the end of the week.
- Provided telephonic and web-based outreach to provide informational support to assist with the Qualified Health Plan selection, application completion, and benefit termination processes.
- Worked collaboratively with other Covered CA department operations to ensure the call center experiences were optimized.
Medical Claims Management
Medi-Syn Inc.
Anaheim, USA
09.2014 - 11.2015
- Was responsible for following up on denied medical claims.
- Handled customer service calls for patient billing statements and health coverage questions.
- Provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims.
- Post EOB’s and patient payments for month end.
- Reviewed corrected claims from Providers to determine if additional benefits were due.
- Maintain a diary system that assures that each assigned claim will receive necessary ongoing attention.
- Updated coordination of benefits and reviewed explanation of benefits in order to submit the claim to the correct party to be paid.
Internship-Medical Billing
Medi-Syn Inc.
Anaheim, USA
08.2014 - 09.2014
- Up keep on medical billing for doctors.
- Completed all electronic CMS 1500 fillings.
- Researched any denied claims.
- Verified patients’ eligibility and claims status with insurance company.
- Precisely completed appropriate claims paperwork, documentation, and system entry.
Education
Medical Billing Insurance and Coding -
UEI College
Anaheim, CASkills
- Health Insurance
- Managed Health Care
- Knowledge of medical terminology
- HIPAA
- Medi-Cal/Medicare knowledge
- Strong problem solving ability
- Microsoft Word
- Microsoft Excel
- PowerPoint
- Detail oriented
- Excellent communication skills
References
References upon request
Timeline
Payment Poster
R1 Rcm
10.2018 - Current
SHOP Call Center Representative I
Pinnacle Claims Management.
11.2015 - 10.2018
Medical Claims Management
Medi-Syn Inc.
09.2014 - 11.2015
Internship-Medical Billing
Medi-Syn Inc.
08.2014 - 09.2014
Medical Billing Insurance and Coding -
UEI College