Krystal Zelada
Henderson
Summary
To pursue a challenging and rewarding position that will utilize my skills and education of the betterment of a company.
Ability to quickly master new roles, responsibilities and environments Ability to work in a team environment as well as independently Extensive experience in handling confidential and sensitive records Over 16 years of work experience in the healthcare industry
Overview
14
14
years of professional experience
Work History
Hospital Billing Representative
UHS Western CBO
Las Vegas
10.2019 - 02.2021
- Heavy insurance verification for HMO and Medicaid payers
- Reviewed and validated accuracy of charges, modifiers and dates of service in a timely manner
- Prepare and mail paper claims with complete medical documentation
- Re-submit claims as needed with corrected/updated information
- Assist with management and providers to resolve any billing issues
Lead, Claims Processing/Adjustments
Molina Healthcare
Long Beach
04.2013 - 09.2019
- Claims processing for Inpatient, Outpatient, Professional and COB claims in an efficient and timely manner, meeting all required guidelines.
- Knowledge in all lines of business- Medicare, Medicaid, Marketplace
- Review and complete all provider/member appeals within 30 day TAT
- Submit contract changes and member eligibility updates to external departments
- Complete all special projects and state complaints submitted by the health plan in a timely manner
- Review and clear out all queues in the Claims Workflow application
- Attend weekly and/or bi-weekly meetings with all Health Plans
- Review audit rebuttals and provide feedback to examiners/adjusters
- Control daily inventory and assign tasks to production staff
- Assist in new hire training/peer cross training
- Assist with the Learning and Development team in updating guidelines for claims processing
HMO Billing Representative
Bowers/Pacific Ambulance
Long Beach
02.2007 - 08.2012
- Research and resolve incorrect payments, EOB’s and other issues with outstanding accounts
- Answer and resolve patient billing inquiries
- Heavy data entry for HMO/Medicaid/Medicare claims
- Follow-up on all A/R and patient aging reports
- Re-submit insurance claims as needed within timely filing limit
- Verify authorizations and request retro-authorizations from insurances/IPA’s
- Prepare daily bank deposits from LockBox and deposit mail checks
- Accurately apply payments to patient accounts and re-bill underpayments
- Balance daily and monthly cash reports for both companies
Education
Medical Billing Certificate -
Bryman College
08.2005
Diploma -
Leuzinger High School
06.2004
Skills
- Payment posting
- Insurance verification
- Claims processing
- Medical billing
- Appeals management
- Customer relationship management
- Compliance standards
- Data entry accuracy
- Attention to detail
- Time management
- Data entry expertise
- Account reviews
- Insurance claims
- Dispute resolution
- Data entry experience
- Cash posting
- Medical billing and collections
Timeline
Hospital Billing Representative
UHS Western CBO
10.2019 - 02.2021
Lead, Claims Processing/Adjustments
Molina Healthcare
04.2013 - 09.2019
HMO Billing Representative
Bowers/Pacific Ambulance
02.2007 - 08.2012
Medical Billing Certificate -
Bryman College
Diploma -
Leuzinger High School