Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kimberly M Toscano

CA

Summary

Senior level Hospital billing expert with proven track record in financial accuracy and efficiency. Skilled in managing invoicing, reconciliations, and payment processing with focus on compliance and timeliness. Strong collaborative abilities and adaptability ensure effective teamwork and optimal results. Known for reliability, adaptability, and results-driven approach. Looking to obtain a full-time, long-term position in a field that not only capitalizes on my existing experience and allows me to grow within the company but shares a mutual respect and transparency.

Overview

17
17
years of professional experience

Work History

Senior Epic Hospital Biller III

Providence St. Joseph's Healthcare
11.2022 - Current
  • Company Overview: Revenue Cycle Management
  • Responsible for hospital claims billing through Epic
  • Addressed claims edits through Epic Billing system
  • Filed all claims on both UB-04. CMS -1500 and 837 file formats and verifies that claim is clean and free of errors before its released
  • Ensured that claims are submitted within a timely manner
  • Submits rebill requests received from Follow Up and Denial department
  • Responsible for reviewing DNSP Reports for aged claims 10+ days to ensure all claims are submitted timely
  • Ensured correct coding initiatives are met for clean claim submissions and correction of claim billed and collected on behalf of the providers
  • Researched payments and posting discrepancies, when required for review by follow up team.
  • Assured that information in Epic is properly entered and accurate
  • Submitted appropriate itemization and documentation when required by payor
  • Escalated edits and errors to appropriate departments for review, when necessary
  • Attended training meetings for updated payor protocols and assisted in training of other caregivers on the same protocols
  • Executed billing tasks and recorded information in payor databases.
  • Organized and detail-oriented with a strong work ethic.
  • Demonstrated strong organizational and time management skills while managing multiple projects.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Enhanced team productivity by providing training on new billing software and processes.
  • Reduced billing errors by implementing strict policies and systematic procedures.
  • Conducted regular audits of billing records, identifying issues and implementing corrective actions.
  • Streamlined the billing process by automating data entry tasks, leading to improved efficiency and accuracy.
  • Ensured compliance with relevant regulations and industry standards throughout all aspects of the billing process.
  • Maximized efficiency within the department by cross-training team members on various aspects of the billing cycle.
  • Managed a high volume of invoices, prioritizing workload to meet deadlines and maintain cash flow.
  • Minimized lost revenue by proactively identifying inaccuracies within invoicing records and taking necessary corrective actions.
  • Determined proper codes for medical records and patient services.
  • Kept all patient information secure and confidential.
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
  • Worked with multiple departments to check proper billing information.
  • Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
  • Audited and corrected billing and posting documents for accuracy.

Denials Representative (Temp/Contract)

Swedish Health Services/Providence St. Joseph's
01.2022 - 07.2022
  • Company Overview: Contract
  • Responsible for rectifying claims denials in a timely manner, routing ICD-10 and CCI edits to the proper Coding departments for review
  • Submitted appeals to support medical necessity or justify the billing of a service or procedure for erroneously denied claims
  • Identified denial trends or to avoid future denials by other payors, to maintain timely reimbursement without incident
  • Ascertained denial reasons for plans that reimbursed like Medicare and submitted appropriate documentation for consideration, including but not limited to primary Explanations of Payment and/or medical records
  • Identified appropriate payor information for claims that were denied for incorrect or terminated coverage reasons
  • Assisted other representatives in their areas of responsibility when needed
  • (via Robert Half)
  • Exceeded performance targets through diligent work ethic and focus on results-driven tasks.

Billing and Collections Representative

UCI Health
09.2019 - 12.2021
  • Company Overview: Physician Billing Group
  • Responsible for performing a critical function for the Physicians Billing Group (PBG) and its clientele by taking the appropriate billing, collections or Customer Service actions to resolve an account
  • Understanding of payer guidelines for Medicare, Medi-Cal (and its affiliates), Commercial Insurance, Workers Compensation and various other insurance carriers, including Tricare, Triwest Healthcare Alliance and VA
  • Required to perform any/all of the following duties: work billing editing error report(s) prior to the submittal of claims to ensure that claims are billed cleanly and free of errors, leading to prompt and maximum pro-fee reimbursement
  • Collecting on insurance and self-pay invoices/accounts with balances as generated and outlined on assigned account receivable worklists, aging reports, system target files and correspondence received and assigned
  • Submission of supporting medical documentation for reimbursement purposes while maintaining HIPAA compliance
  • Verification of patient eligibility upon denials for terminated coverage
  • Review of underpaid claims to verify that providers are reimbursed according to contract
  • Participation in monthly COE meetings, while reviewing reports of productivity and outstanding denials and unpaid claims
  • Submission of appeals for erroneously denied invoices
  • Requests for retro-authorization
  • Completion of Charge Corrections
  • Reviewed collection reports to determine status of collections and amounts of outstanding balances.
  • Identifying denial and EPIC claims rejection trends and finding resolutions to avoid the issue on future claims
  • Physician Billing Group
  • Improved collections efficiency by implementing strategic negotiation techniques and customer service skills.
  • Proficiently navigated industry-specific software tools for efficient tracking, reporting, and analysis of collection efforts.
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
  • Demonstrated exceptional problem-solving abilities in addressing complex collection scenarios, leading to successful resolutions.
  • Handled highly sensitive information responsibly while maintaining strict confidentiality standards.
  • Researched accounts and completed due diligence to resolve collection problems.

Patient Accounting Govt and Non-Govt Collector

Hoag Memorial Hospital Presbyterian
01.2018 - 09.2019
  • Served as the account representative for Hoag Hospital in working with insurance companies and/or non-government for resolution of payments
  • Completed accounts assigned daily on collection worklists
  • Responsible for all HealthNet accounts for both Hoag and Hoag Orthopedic Institute as well as all MSI accounts/claims
  • Worked to obtain the maximum reimbursement by evaluating claims at the contract rate with the use of contract management tool for proper pricing of claims (APC,DRG)
  • Reviewed and initiated the initial appeal for underpaid claims while observing all timely requirements to secure reimbursement due to Hoag
  • Managed and maintained over $4,000,000.00 in accounts
  • Conducted audits of accounts for billing and commercial requirements
  • Assisted in identifying charge capture and missing charges on claims
  • Recommended denial edits to help mitigate denial issues
  • Escalated payer accounts that need to be appealed due to improper billing, coding, and/or underpayments
  • Reported new and unknown EPIC billing edits to direct supervisor for review and resolution
  • Have thorough knowledge of managed care contracts, current payer rates, understanding of terms and conditions and Federal and State requirements
  • Interpreted Explanation of Benefits and Electronic Remittance Advices to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans
  • Strong and thorough understanding of hospital billing for requirements UB04 and HCFA 1500 forms

Reimbursement-Collections Specialist

Clinical Practice Management
07.2015 - 01.2018
  • Responsible for managing Accounts Receivable for 6 Physical Therapy clinics and maintaining collectibles at 10% or less
  • Appeals denied insurance claims and demands payment from responsible parties
  • Responsible for managing over $1,000,000.00 in accounts
  • Implementing diagnosis requirements for claims payment (for specific Pediatric policies and private insurance carriers)
  • Manages staff/employees of clinics to meet guidelines
  • Maintains HIPAA compliance
  • Monthly meetings to review accounts 120 days past due
  • Running, reviewing and working aging reports

Patient-Client Care Liaison / Marketing

Golden Age Companions
07.2014 - 07.2016
  • Serve as a liaison between the patient, family, hospital staff and physicians to ensure a favorable patient experience and efficient coordination of unit flow
  • Responsible for a variety of clerical and non-clerical duties that support the overall operations of the nursing unit as well as the optimal delivery of care within the health system
  • Routinely engaged in identifying, elevating and providing alternative solutions to challenges to appropriate personnel
  • Provide timely information to decision-making personnel
  • Liaise with healthcare professionals in order to build relationships and receive referrals
  • Distribute information about the companies' products to physicians, hospitals, nurses, and medical technicians
  • Encourage doctors to refer patients to Golden Age Companions
  • Deliver market research to healthcare professionals
  • Answering questions about the in-home senior care and why it is generally the best option for the patient
  • Giving presentations to doctors and staff
  • Working alongside the president to develop strategies to approach potential customers
  • Keeping informed about competitors services
  • Maintained a computer database to record all sales and detailed records of all contacts, both potential and existing

Office Manager/Billing Specialist

Southside Physical Therapy and Training Center
03.2014 - 05.2015
  • General office management, including Human Resources duties
  • Medical bills/billing
  • Customer service: greeting patients, maintaining 3 line phone system
  • Data Entry into EMR program (Webpt) (50 WPM and 10 Key)
  • Responsible for processing and maintaining all patient accounts
  • Verifying medical benefits (both HMO and PPO)
  • Maintaining patient payments and schedule
  • Responsible for collecting copayments/co-insurance and deductibles
  • Manually reconcile patient counts and billing at day's end
  • Auditing of outstanding accounts (A/R) in EZ-Claim billing system
  • Re-billed and corrected claims previously denied (billed by old biller)
  • Claims appeals
  • Electronic and Paper billing
  • Created new forms
  • Responsible for Advanced Beneficiary Notices for Medicare patients
  • Responsible for monitoring patient's annual Medicare Caps and remaining Medicare compliant
  • Schedule patients, reminder calls and follow ups
  • Constant communication with doctors office to maintain accurate and current patient information
  • Scheduling doctor lunches
  • Knowledge of ICD-9 and CPT codes (currently educating myself on ICD-10 Codes)
  • Transitioned clinic from paper charts to paperless E-docs
  • Correspondence with insurance companies and attorneys for patient medical records
  • Negotiating Personal Injury Liens

Patient Account Coordinator

Southern California Aquatic Therapy
05.2013 - 05.2014
  • General office management
  • Medical bills/billing
  • Customer service: greeting patients, maintaining 3 line phone system
  • Data Entry into EMR program (Webpt) (50 WPM and 10 Key)
  • Responsible for processing and maintaining all patient accounts
  • Verifying medical benefits (both HMO and PPO)
  • Maintained schedules and appointments for 4 physical therapists
  • Responsible for collecting copayments, deductibles and any payment for product
  • Manually reconciled patient counts and billing at day's end
  • Communicated with Momentum Billing between biller and therapists
  • Some auditing of outstanding accounts in PTOS billing system
  • Created new forms
  • Responsible for Advanced Beneficiary Notices for Medicare patients
  • Schedule patients, reminder calls and follow ups
  • Constant communication with doctors office to maintain accurate and current patient information
  • Knowledge of ICD-9 and CPT codes (currently educating myself on ICD-10 Codes)
  • Transitioned clinic from paper charts to paperless E-docs
  • Guided walk-ins through tour of facility
  • Tracked patient activity
  • Correspondence with insurance companies and attorneys for patient medical records

Assistant Office Manager / Administrative Assistant

Alamitos Physical Therapy
05.2008 - 05.2013
  • General office management
  • Customer service: greeting patients, maintaining 2 line phone system
  • Data Entry (50 WPM and 10 Key)
  • Responsible for all medical bills and billing
  • Responsible for company email correspondence with patients and vendors
  • Maintained schedules and appointments for 4 physical therapists
  • Process all patient information
  • Verify benefits and obtain payment
  • Collect co-pays from patients
  • Mail notices of delinquency to patients not in good standing
  • Contact attorneys to process and negotiate personal injury lien cases
  • Balance accounts
  • Process worker's comp claims and contact adjusters for payment
  • Appeal unpaid and denied claims
  • Compare patient billing to insurance company records
  • Contact doctors if necessary to obtain additional information
  • Obtain authorizations (work comp and private insurance)
  • Provide Physical Therapist with ICD-9 and CPT codes
  • Initiate, administrate, and edit WebPT and HealthPro8000 entries

Physical Therapy Aide

Alamitos Physical Therapy
05.2008 - 06.2009
  • Evaluated patient chart
  • Open and close office location
  • Greeted patients
  • Taught patients therapeutic exercise routine before
  • Followed up with patients to finish their routine after Physical Therapist is done
  • Operated equipment for: Electrical stimulation, Whirlpool, Parafin bath, Moist heat, Cold laser, Ultrasound, Ice massage
  • Assisted front desk by answering phones, scheduling appointments, filing documents and processing payments.
  • Enhanced patient comfort and safety by setting up equipment, preparing treatment areas, and positioning patients as needed.
  • Contributed to positive patient outcomes by closely monitoring progress and providing timely updates to supervising therapists.
  • Optimized scheduling efficiency through coordination with administrative staff members, minimizing appointment conflicts for both therapists and patients.
  • Maintained supply inventory by placing orders when supplies ran low.
  • Maintained strict compliance with HIPAA regulations, ensuring the privacy and confidentiality of sensitive patient information at all times.
  • Improved patient recovery by assisting in implementing individualized physical therapy treatment plans.
  • Provided empathetic support to patients experiencing difficult emotions related to their injury or illness while under supervision from a licensed therapist.
  • Recorded patient status in progress notes.
  • Enforced safety procedures with all patients.
  • Performed electrical stimulation, ultrasounds, matrix, myofascial release and spot massages to improve patient movement and functions.

Education

American Academy of Professional Coders (AAPC)
11-2024

Fullerton College
07.2022

Cypress College
07.2019

High School Diploma -

John F. Kennedy High School
06.2003

Skills

  • EPIC Billing
  • SSI
  • OneHealth
  • Passport
  • Craneware
  • Availity
  • WebPT
  • Complete MS Office Suite
  • HealthPro 8000
  • Practice Perfect
  • Nthrive
  • Optum Encoder/Encoder Pro
  • Craneware
  • Previous Patterson Technologies PTOS
  • Office Ally
  • EZ Claim billing system
  • American Sign Language
  • Current Covid Billing Experience
  • Newborn/Mom&Baby Billing
  • Knowledge of Medi-Cal/Medicaid programs
  • Knowledge of required International Coding of Diseases - 10 (ICD-10) and (ICD-9)
  • Strong understanding of Revenue Cycle processes
  • Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage Covered California, capitation and commercial payers
  • Insurance billing procedures
  • Technical aptitude
  • Collections
  • Billing systems and software
  • Payment posting
  • Hospital and Professional Billing
  • Data entry proficiency
  • Payment tracking
  • Numeric accuracy

Timeline

Senior Epic Hospital Biller III

Providence St. Joseph's Healthcare
11.2022 - Current

Denials Representative (Temp/Contract)

Swedish Health Services/Providence St. Joseph's
01.2022 - 07.2022

Billing and Collections Representative

UCI Health
09.2019 - 12.2021

Patient Accounting Govt and Non-Govt Collector

Hoag Memorial Hospital Presbyterian
01.2018 - 09.2019

Reimbursement-Collections Specialist

Clinical Practice Management
07.2015 - 01.2018

Patient-Client Care Liaison / Marketing

Golden Age Companions
07.2014 - 07.2016

Office Manager/Billing Specialist

Southside Physical Therapy and Training Center
03.2014 - 05.2015

Patient Account Coordinator

Southern California Aquatic Therapy
05.2013 - 05.2014

Assistant Office Manager / Administrative Assistant

Alamitos Physical Therapy
05.2008 - 05.2013

Physical Therapy Aide

Alamitos Physical Therapy
05.2008 - 06.2009

Fullerton College

Cypress College

High School Diploma -

John F. Kennedy High School

American Academy of Professional Coders (AAPC)

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Kimberly M Toscano