Krystal Cruz
Rome,NY
Summary
Motivated Medical Biller with seven years of dedicated experience and a deep understanding of the billing process. Adept at managing claim submissions, ensuring precise documentation, and collaborating closely with providers. Committed to improving billing efficiency while maintaining compliance with industry standards and regulations. Eager to learn new skills. I am a fast and motivated learner.
Overview
23
23
years of professional experience
Work History
Account Manager/Claims Specialist
Solutions Medical Billing
07.2017 - Current
- In my role as an Account Manager and Claims Specialist, I oversee all aspects of claims processing for specific provider
- Accounts including documentation review, coding accuracy, and communication with both providers and patients
- I specialize in optometry billing while ensuring claims are processed efficiently and with minimal errors
- Conducts thorough reviews of claims submitted by providers, verifying service dates, eligibility, patient demographics, and coding accuracy to ensure all claims meet insurance standards and requirements
- Resolves complex coding errors by applying specialized knowledge in ICD10 and CPT coding, improving the accuracy and approval rate of claims submitted for processing
- Manages Epaces billing for office visits, coordinating closely with providers and their staff to troubleshoot issues and identify solutions for claim discrepancies and payment delays
- Follows up consistently on denied claims, investigating issues related to coding, in network and out of network discrepancies, eligibility, authorizations and any errors made while taking patient demographics
- Generates comprehensive monthly aging reports for insurance claims nearing timely filing deadlines, allowing proactive management and reducing the risk of missed revenue opportunities
- Prepared and submitted detailed appeal documentation for denied claims, gathering supporting evidence and adhering to payer guidelines to increase the likelihood of a successful appeal outcome
- Proficient in Medicaid billing via Epaces, ensuring prompt payment from secondary and tertiary claims
- Consistently adhered to HIPAA regulations, maintaining confidentiality and protecting patient data while implementing best practices in compliance and documentation management
Softlines Customer Service Representative
Walmart Super Center
12.2004 - 04.2006
- In my role as a Softlines Customer Service Representative, I delivered high-quality customer service in a fast-paced retail environment, focusing on resolving customer inquiries and maintaining an organized and well-stocked sales floor
- I ensured seamless operations by managing inventory and supporting merchandising efforts
- Provided responsive and knowledgeable customer service, assisting shoppers with inquiries, resolving routine complaints, and delivering solutions that enhanced the overall customer experience
- Managed inventory processes, including stocking shelves, organizing backstock, updating price tags, and executing markdowns, ensuring the sales floor remained well-stocked and visually appealing
- Collaborated with the merchandising team to set up, maintain, and refresh product displays according to the latest sales strategies, enhancing product visibility and driving sales performance
- Assisted customers in fitting rooms, promptly returning items to their correct departments, and ensuring smooth transitions between sales floor and backroom inventory management processes
Customer Service Representative
Kmart
03.2002 - 12.2004
- In my role as a Customer Service Representative, I played a key role in providing a positive shopping experience through exceptional customer service, accurate payment processing, and proactive problem-solving
- I ensured customer satisfaction while supporting store operations through inventory management and product recommendations
- Handled customer transactions with precision, processing payments through various methods, including cash and credit, while maintaining accuracy and speed at the checkout, ensuring smooth and efficient service
- Developed strong customer relationships by consistently delivering friendly service, promptly addressing inquiries, and offering solutions tailored to individual customer needs, resulting in repeat business
- Assisted customers with selecting products, sharing up-to-date knowledge of store promotions, and actively suggesting items to meet their needs, contributing to increased sales and customer satisfaction
- Managed returns and exchanges by processing them accurately in the company database and ensuring returned merchandise was restocked or marked for clearance as per store policies
Education
Certificate - Health Information Technology
Mohawk Valley Community College
05.2017
Skills
- Comprehensive Documentation Review
- Coverage Assessments
- Microsoft Office Proficiency
- Lytec Billing Software
- Medical Terminology and ICD-10 Coding
- Efficient Data Entry
- Insurance Claims Processing and Denials Management
- Patient Rapport and Communication
- Customer Service Excellence
- Medicaid Knowledge and Compliance
- Insurance Terminology and Claims Forms Review
- Account Management and Reconciliation
Awards
DEANS AWARD-2017,2016, Mohawk Valley Community College, Utica, NY, PRESIDENT'S AWARD-2016, Mohawk Valley Community College, Utica, NY
Timeline
Account Manager/Claims Specialist
Solutions Medical Billing
07.2017 - Current
Softlines Customer Service Representative
Walmart Super Center
12.2004 - 04.2006
Customer Service Representative
Kmart
03.2002 - 12.2004
Certificate - Health Information Technology
Mohawk Valley Community College
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