Kelly Morales
Knights Landing,CA
Summary
To obtain fulltime employment, which will allow me to perform my duties in a job I enjoy and to ultimately help with the success and the growth necessary to remain operating in today's economy.
Professional billing expert with strong expertise in financial analysis, invoicing, and account reconciliation. Proven track record in optimizing billing processes and resolving discrepancies efficiently. Known for collaborative teamwork, adaptability, and achieving organizational goals. Skilled in medical coding, insurance claims, and ERP systems.
Overview
1
1
Certification
18
18
years of professional experience
Work History
Billing Specialist Manager
Griffin & Reed Eye Care
Knights Landing, CA
09.2013 - 08.2026
- Managed patient billing and collections, increasing collection efficiency by streamlining processes
- Credentialed providers for PPO insurance compliance with CAQH standards.
- Obtained authorization for various billing procedures to ensure compliance.
- Managed patient billing and collections, streamlined processes to enhance collection efficiency
- Corrected denied claims and resubmitted for payment, increasing claim approval rates; filed appeals and assisted patients with member-submitted appeals
- Process ERA payments worked EOBs to ensure payments matched fee schedules, maintaining accurate financial records
- Corrected denied claims and resubmitted for payment to improve claim approval rates; filed appeals and supported patients with member-submitted appeals
- Prepared documentation necessary for accurate payment distribution to correct entities
- Met weekly deadlines and completed month-end closing, ensuring timely financial reporting
- Established provider credentials for PPO insurance requirements set by CAQH.
- Filed documents, answered phone calls, scheduled patient appointments, and resolved operational issues.
Billing Supervisor
Trinidad Medical
Roseville, CA
12.2008 - 05.2012
- Processed daily insurance claims to PPO, HMO, workers compensation, and Medicare Medi-cal using electronic and paper formats (CMS-1500 or UB-04).
- Post daily deposits from insurance companies from the Explanation of Benefits. (EOB)
- Posted daily deposits from insurance companies based on Explanation of Benefits (EOB) to ensure accurate financial records.
- Assisted patients with resolving insurance issues and inquiries to enhance customer satisfaction.
- Weekly A/R collections calls.
- Assist patients with insurance problems and questions.
- File appeals or redeterminations.
- Answered phones and addressed patient inquiries in a timely manner.
Senior Billing Specialist
Active Diagnostic Inc
Woodland, CA
09.2008 - 01.2012
- Process daily insurance claims to PPO, PI's, workers compensation, and Medicare, Medi-Cal Claims. CMS-1500 or UB-04.
- Managed primary and secondary insurance claims for various territories.
- Posted daily deposits from insurance companies based on Explanation of Benefits (EOB).
- Billed patients for co-payments and deductibles.
- Prepare and bill Purchase Order invoices.
- Weekly A/R collections calls.
- Submitted appeals to insurance companies for claim reconsideration.
Senior Billing Specialist
Active Diagnostic Inc
09.2008 - 12.2011
- Coordinated Neuro Surgical Monitoring cases, ensuring accurate billing for specialized procedures
- Processed daily insurance claims to PPO, PI's, workers compensation, and Medicare, including primary and secondary claims, maximizing reimbursements
- Verified patient insurance coverage to ensure accurate and timely billing
- Balanced patient bills for co-payments and deductibles while assisting with insurance issues, enhancing collection rates
- Balanced bill patients for co-payments and deductibles, and assisted patients with insurance issues, improving collection rates
- Filed appeals for denied claims, resulting in higher claim approval rates
- Filed appeals to recover denied claims, increasing claim approval rates
- Managed incoming phone calls to ensure prompt customer service, filed documents, and resolved problems to support efficient office operations
Education
High School Diploma -
Jefferson High School
Daly City, CASkills
- Medical billing
- Claims Claims processing
- Billing Compliance
- Revenue cycle management
- Electronic health records
- CMS-1500
- UB-04 forms
- ICD-10 coding
- CPT coding standards
- Payment processing
- Benefits explanation
- Insurance Verification
- Attention to detail
- Process improvement
- Root cause analysis
- Critical thinking
- Practice management
- Microsoft Outlook
- ICD-10 coding
Certification
- CMS Noridian Healthcare Solutions
- Certified Top Inquires and Solutions [2013-2026]
- Certified [ Medicare Billing Basics], BSM - 1/24/2017
Personal Information
Title: Billing Specialist Manager - Griffin & Reed Eye Care
Timeline
Billing Specialist Manager
Griffin & Reed Eye Care
09.2013 - 08.2026
Billing Supervisor
Trinidad Medical
12.2008 - 05.2012
Senior Billing Specialist
Active Diagnostic Inc
09.2008 - 01.2012
Senior Billing Specialist
Active Diagnostic Inc
09.2008 - 12.2011
High School Diploma -
Jefferson High School