Kelly De Los Santos
Casselberry,USA
Summary
Healthcare professional with over 30 years of experience in medical billing, proficient in EWC, Epic, and Centricity systems. Expertise in CPT, ICD-10, and HCPCS coding, ensuring accurate billing and compliance. Analytical specialist known for providing effective solutions to current challenges and implementing improvements. Demonstrates a proactive approach, adaptability, and a strong work ethic in all tasks.
Overview
23
23
years of professional experience
Work History
Revenue Cycle Specialist
Firstsource Solutions
REMOTE, FL
07.2024 - 05.2025
- Reviewed patient accounts to ensure accuracy and completeness of information.
- Analyzed claims data to identify trends in denials and rejections.
- Audited payments from third-party payers to ensure accuracy of reimbursement amounts.
- Monitored accounts receivables daily to determine appropriate follow-up action needed.
- Researched discrepancies on unpaid invoices and reconciled them.
- Maintained current knowledge of insurance policies, procedures, regulations, and guidelines.
- Reached out to responsible companies and individuals to collect on outstanding debts.
- Contacted insurance providers to check patient coverage.
- Identified and corrected payment problems involving patients or third-party payers.
Accounts Receivable Specialist
Conifer Health Solutions
Frisco, TX
07.2023 - 03.2024
- Reviewed and verified accuracy of invoices and account balances for timely resolution.
- Conducted phone calls to insurance carriers regarding outstanding hospital claims.
- Followed up on all outstanding claims for multiple hospitals nationwide.
- Assessed accounts to determine next steps for resolving outstanding balances.
- Evaluated multiple job aids to ensure compliance with company policy.
- Completed additional projects and tasks as assigned.
Insurance Billing Specialist
Insura Billing Services
Winter Garden, FL
03.2022 - 10.2023
- Conducted thorough insurance verification and account reviews for accuracy.
- Generated patient estimates for services based on insurance coverage.
- Resolved high volume, time-sensitive patient and practice inquiries efficiently.
- Assisted various offices with copays, co-insurance, and deductible calculations.
- Processed payments from insurance companies per established protocols.
- Reviewed insurance claims to ensure completeness and accuracy of information.
- Identified trends in denied claims, collaborating with staff on corrective actions.
- Submitted appeals to insurance companies and followed up on unpaid claims.
Billing Specialist
Masri Medical
Apopka, FL
10.2019 - 02.2020
- Verified charges prior to electronic submission, ensuring accurate modifiers and dx pointers for optimal reimbursement.
- Posted payments from paper EOBs and reconciled payments not posted from ERA.
- Followed up on all denials and low reimbursements to secure payment resolutions.
- Analyzed A/R reports based on aging of outstanding charges to prioritize collection efforts.
- Obtained necessary precertification and authorization for in-office procedures.
- Conducted benefits verification to confirm patient coverage.
- Reviewed patient accounts for outstanding balances, credits, or overpayments.
- Managed all aspects of Insurance Billing through E-Clinical Works EMR system, following established practices.
Insurance and Billing Supervisor
UROLOGY CONSULTANTS
Longwood, FL
09.2016 - 08.2018
- Entered physician and P.A. charges daily, including insurance and patient payments, adjustments, and no pays.
- Coded and submitted surgical charges using current CPT, ICD-10, HCPCS codes, and modifiers while adhering to NCCI edits for optimal payment.
- Obtained and reviewed precertifications, authorizations, and referrals from primary care physicians or directly from insurance carriers.
- Reviewed accounts for accurate payments and adjustments, appealing any denials of valid charges.
- Processed refunds to patients and insurance carriers for overpaid services.
- Sent patient statements for outstanding balances and established payment plans for those unable to pay in full.
- Corrected electronic claims rejections and front-end edits prior to claim submission.
- Analyzed multiple reports including outstanding claims, aging, production, and revenue reports.
Health Insurance Specialist
Orlando Orthopaedic Center
Orlando, FL
05.2005 - 09.2016
- Managed posting of Physical Therapy and Ancillary charges across five therapy locations and two MRI facilities.
- Balanced daily batches from multiple offices, maintaining accuracy in financial records.
- Handled payment posting of physical checks and EFTs, ensuring daily balance integrity.
- Facilitated review of low reimbursements and no pay cases with Insurance Financial Counselors.
- Coordinated timely electronic and paper claim submissions with appropriate documentation.
- Conducted reviews on rejected claims to ensure prompt dispatch of clean claims.
- Functioned as a Float, covering roles such as payment posting and surgical precertification.
- Supported training initiatives for new hires while managing special projects independently.
Transcriptionist
Orlando Orthopaedic Center
Orlando, FL
04.2002 - 05.2005
- Transcribed progress notes and letters for 17 physicians using Microsoft Word at 130 wpm.
- Managed transcription workload for three physicians, resolving backlogs efficiently.
- Reviewed all notes for grammatical accuracy, correcting errors swiftly.
- Facilitated document submission to PCPs, Work Comp adjusters, and No Fault carriers via fax.
Education
High school diploma - Accounting
Florida Metropolitan University
Orlando, FL12.1999
Medical -
Del Mar College
Corpus Christi, TX05.1991
Skills
- Billing and coding expertise
- Claims processing and insurance verification
- Accounts management
- Proficient in Microsoft Office applications
- EClinicalWorks experience
- Data entry skills
- Terminology in medical fields
- Compliance with HIPAA regulations
- Effective communication and phone skills
- Financial oversight and analysis
Languages
English, Expert
Assessments
- Protecting patient privacy, Proficient, 12/01/21
- Management & leadership skills: Impact & influence, Proficient, 03/01/21
References
References available upon request.
Timeline
Revenue Cycle Specialist
Firstsource Solutions
07.2024 - 05.2025
Accounts Receivable Specialist
Conifer Health Solutions
07.2023 - 03.2024
Insurance Billing Specialist
Insura Billing Services
03.2022 - 10.2023
Billing Specialist
Masri Medical
10.2019 - 02.2020
Insurance and Billing Supervisor
UROLOGY CONSULTANTS
09.2016 - 08.2018
Health Insurance Specialist
Orlando Orthopaedic Center
05.2005 - 09.2016
Transcriptionist
Orlando Orthopaedic Center
04.2002 - 05.2005
High school diploma - Accounting
Florida Metropolitan University
Medical -
Del Mar College
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