Noemi Orona
Summary
Highly motivated, independent, reliable, and self-starter with years of extraordinary experience as a Medical Administrative Assistant, Medical Biller, and Excellent Customer Service representative. Demonstrated ability to work well under strict deadlines with close attention to detail, consistently excelling in roles. Seeking an opportunity to continue professional growth and provide exceptional service in a new setting.
Overview
16
16
years of professional experience
Work History
RCM-Patient Service Representative
Allergy Partners
01.2024 - Current
- Managed high call volumes while providing exceptional customer support and maintaining professional composure.
- Consistently demonstrated a strong work ethic, arriving punctually for shifts and maintaining focus on providing top-tier service throughout entire workday.
- Mastered multiple software systems for seamless navigation during calls, improving efficiency and reducing hold times for customers.
- Documented patient accounts with precision to ensure accurate records.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Reached out to insurance companies to verify coverage.
- Coordinated patient payment plans, to ensure timely payments while preserving positive patient relationships.
- Maintained clear documentation of all activities related to unpaid claims or denied services.
- Provided regular updates on billing status to upper management through detailed reports.
- Enhanced transparency of financial policies to patients.
- Streamlined billing processes, significantly reducing errors in patient invoices by meticulously auditing and correcting discrepancies.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Identified and resolved patient billing and payment issues.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Collected payments and applied to patient accounts.
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Liaised between patients, insurance companies, and billing office.
- Efficiently processed refunds or adjustments for patients when necessary, ensuring accuracy and compliance with company policies.
- Participated in departmental meetings, sharing insights and ideas for improving overall medical billing.
- Conducted regular audits of patient accounts for potential underpayments or overpayments due to incorrect coding or billing practices.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Set up patients on automatic monthly payments, following the company guidelines.
- Train any new hires whenever assigned by Management.
- Configured patient accounts for automatic monthly payments, adhering to established company procedures.
- Other duties assigned by Management
- Protected RCM operations by maintaining strict confidentiality of patient information in line with HIPAA standards.
- Displayed personal commitment to achieving corporate goals by maintaining professionalism and fostering positive relationships with all business contacts.
Financial Counselor
American Oncology Network
06.2023 - 01.2024
- Conducted interviews with patients and family members and answered questions regarding insurance benefits.
- Identified healthcare resources and programs for patients unable to meet
- Contacted insurance providers to obtain key information regarding patient benefits and to submit documentation for accounts.
- Worked directly with clients to provide financial counseling and education using individualized counseling model and personal finance course. Helped clients identify and set short- and long-term financial and life goals and devise plans to reach those goals.
- Liaised between patient, doctor and insurance provider to smooth claims processes.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Assisted clients with completion of applications and paperwork. Developed and maintained a comprehensive grants calendar to ensure timely submissions, progress reports, and evaluations.
- Coordinated, monitored, assigned, and documented patient and clinical care activities.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Updated patient records with accurate, current insurance policy information.
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
Prior Authorization Specialist
WEST DERMATOLOGY
05.2021 - 06.2023
- Contacted insurance companies to obtain necessary pre-authorizations needed for upcoming tests and procedures
- Performed detailed medical reviews of a prior authorization request, following established criteria and protocols
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions
- Used Availity, Optum, and Health Net Federal to input claims, prior authorization, and other important medical data into the system
- Determine which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage
- Contacted insurance carriers to obtain authorizations, notifications, and pre-certifications for patients
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff, and office personnel by using effective written and verbal communication skills.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Processed patients lacking coverage for planned procedures.
PATIENT FINANCIAL SERVICES/CHARGE ENTRY
West Dermatology
05.2021 - 06.2023
- Assisted patients with billing inquiries and answered any questions about their dermatology bills, adjusted their accounts accordingly based on their EOB, collected payments such as, Deductibles, Co-insurance and copayments offered the ability of payment plans to any patient who was in need of financial assistance, corrected insurance information in patients files and billed the correct information verified the eligibility to assure the patient was not going to be billed in error, submitted multiple corrected claims to ensure the company would get paid accordingly.
- Connected with Insurance and patient aging to resubmit insurance claims when necessary
- Filled paperwork, answered phones directing patients to doctors, billed Medicare/Medicaid
- Conducted necessary internal and external insurance audits to resolve denied or unpaid claims
- Navigated through the clearing house to obtain EOBs, ERA's and any other insurance payment information I needed to accurately assist the patient with their account
- Corrected any charges that were incorrectly entered by the office based on the clinical documentation
- Reviewed and validated accuracy of charges including dates of service, services provided, location and provider signature
- Entered daily pathology charges sent by the pathology department .
- Follow up in a timely manner on delinquent accounts
- Identify true patients account receivables vs Insurance pending payments
- Set up patients on automatic monthly payments
- Answer multiple phone lines in a timely and professional manner.
- Assist my teammates with any billing or scheduling questions whenever necessary
- Train any new hires whenever assigned by Management
- Other duties assigned by Management.
- Researched billing errors and discrepancies to initiate corrective action.
- Entered patient details and notes into system to assure proper documentation.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Audited and corrected billing and posting documents for accuracy.
- Identified payment trends and adjusted billing processes accordingly to retain customers.
- Provided excellent customer service, developing and maintaining client relationships.
- Utilized various software programs to process customer payments.
- Researched and resolved billing discrepancies to enable accurate billing.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Processed eligibility and benefits verification and authorization requests.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Conducted full claim investigations and reported updates and legal actions.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Accounts Receivable Manager
Foot And Ankle Specialist Of Nevada
06.2020 - 05.2021
- Updated aging reports based on daily audits.
- Utilized financial software to prepare consolidated financial statements.
- Completed daily process adjustments to maintain accuracy.
- Prepared internal and regulatory financial reports, balance sheets and income statements.
- Verified discrepancies and resolved patient billing issues
- Reconciled daily AR ledger and verified proper posting.
- Prepared cash flow projections, cost analysis and monthly, quarterly and annual reports.
- Posted patient payments by recording cash, checks, and credit card transactions.
- Analyzed aging reports and provided recommendations for improving collections efforts.
- Created monthly reports detailing accounts receivable performance metrics for senior management review.
- Prepared bills receivable, invoices, and bank deposits.
- Established internal audit procedures to validate and improve accuracy of financial reporting.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Posted payments to accounts and maintained records.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Assisted with medical coding and billing tasks.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Performed various administrative tasks by filing, copying and faxing documents.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Registered and verified patient records before triage with most up-to-date information.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Obtained payments from patients and scanned identification and insurance cards.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Trained new staff on current, correct insurance verification procedures.
- Processed medical insurance claims and payments.
- Updated patient records with accurate, current insurance policy information.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Researched billing errors and discrepancies to initiate corrective action.
- Processed debtor payments and updated accounts to reflect new balance.
- Contacted customers to discuss past-due accounts and negotiated payment plans.
- Established relationships with customers to encourage payment of delinquent accounts.
- Processed billing calls and answered questions from patients and third-party carriers.
- Responded to patient inquiries and provided detailed account information.
- Processed online and paper appeal submissions and refund requests.
- Ensured accurate billing with thorough audits of patient accounts and insurance claims.
- Reached out to insurance companies to verify coverage.
- Assisted patients in understanding complex billing statements, leading to increased trust between patients and healthcare providers.
- Ensured accurate and timely payments by effectively liaising with insurance companies.
FRONT DESK ASSISTANT
PROCARE MEDICAL CENTER
02.2013 - 05.2015
- Managed reception services for busy urgent care including greeting 250-plus patients a day scheduling appointments, updating demographic information, collecting insurance and health information, and inputting all relevant data into the electronic health records
- Collected payments such as co-pays, deductibles and co-ins
- Managed electronic medical records for more than 3500 patients
- Communicated with other offices, hospitals and surgery centers to schedule patient care, Coordinated patient referrals and testing to other medical group departments
- Ensured that all claims information was complete before forwarding to the medical billing office
- Answered phone calls and emails, verified insurance eligibility and checked patients in
- And other tasks assigned by management.
- Completed patient referrals to other medical specialists.
- Printed prescription requests and queries in compliance with practice protocol.
ADMINISTRATIVE ASSISTANT
DAVITA KIDNEY CARE
07.2009 - 02.2014
- Scheduled patient office/ Dialysis appointment treatments
- Processing all inbound/outbound referral orders,
- Reschedule patient appointments due to cancellation
- Accurately schedules and coordinates patient appointments for assigned clinics
- The ability to work in a high call volume environment while meeting productivity and quality standards
- Respond to patient questions over the phone, make patient follow up calls (e.g., after procedures, admissions, or ER visits) to identify/close gaps in care
- Connect patients with outside resources (e.g., community resources, social services) to promote self-care
- Assisted patients with transportation arrangements and physician appointments, ensured the timely and accurate completion of change requisitions, treatment logs, patient charts, invoices
- Helped identify eligible resources for members and worked with Integrated Care Nurses, dialysis clinics, health plans, and other stakeholders to help members enroll in eligible programs
- Process special handling claims and open balance accounts as required, Review payer rules and complete forms appropriately.
- Research, appeal, and resolve claims rejections, underpayment and denials with appropriate payer within payer specified deadlines.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Promoted a positive work environment through effective communication skills and fostering professional relationships among colleagues.
- Maintained inventory of office supplies and placed orders.
- Assisted in preparation of financial reports, gathering data that contributed to budgeting accuracy.
Education
Medical Coding And Billing
Maric College
04.2007
Skills
- Medical coding: ICD-10-CM, CPT and HCPCS
- Teamwork
- Excellent phone etiquette and oral communication skills
- EMR
- Familiarity with Medicare, Medicaid and other insurance programs
- Knowledge of Microsoft Office, Outlook and the ability to operate basic office equipment
- Knowledge of Medical Billing and collections
- Certified Medical Coding and Billing
- A/R management
- Exceptional oral and written communication
- Attention to detail
- NextGen other EHS
- Leadership
- Adaptability
- Ability to read and comprehend explanation of benefits (EOBs)
- Benefit and Eligibility coverage
- Electronic Health Records Systems
- Accounts Payable and Accounts Receivable
- Customer Satisfaction
- Billing Procedures
- Authorizations
- Patient Referral
- Past Due Balance Management
- Problem Resolution
References
- Janaae Paige (702) 204-8604- RCM Manager
- Holly Karapetyan (424)285-4983 -FPS Lead
- Laura Franco (702)690-1024 -Former Supervisor
Languages
Spanish
Native or Bilingual
Timeline
RCM-Patient Service Representative
Allergy Partners
01.2024 - Current
Financial Counselor
American Oncology Network
06.2023 - 01.2024
Prior Authorization Specialist
WEST DERMATOLOGY
05.2021 - 06.2023
PATIENT FINANCIAL SERVICES/CHARGE ENTRY
West Dermatology
05.2021 - 06.2023
Accounts Receivable Manager
Foot And Ankle Specialist Of Nevada
06.2020 - 05.2021
FRONT DESK ASSISTANT
PROCARE MEDICAL CENTER
02.2013 - 05.2015
ADMINISTRATIVE ASSISTANT
DAVITA KIDNEY CARE
07.2009 - 02.2014
Medical Coding And Billing
Maric College
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