Laura Alvarez
Sacramento,CA
Summary
Dynamic professional with extensive experience in medical billing and claims analysis at American Medical Response. Proven ability to enhance operational efficiency and resolve complex billing issues. Skilled in MS Office and bilingual in Spanish and English, I excel in fostering relationships and driving results in fast-paced environments.
Overview
21
21
years of professional experience
Work History
Pre-Billing Specialist/Transfer Coordinator/Dispatcher
American Medical Response (AMR)/CALSTRS/REACH (GMR)
Sacramento, USA
05.2016 - 08.2025
- Reviews the patient care report (PCR) for clarity of patient demographics, billing information, supporting documentation, and information surrounding the patient encounter prior to transferring the report to the Patient Business Services Department for timely billing.
- Work with Dispatch to provide guidance surrounding non-emergency transports and the paperwork or authorizations needed prior to sending a unit to pick up the patient.
- Oversaw repetitive patient process, enhancing care coordination effectiveness.
- Work with Dispatch to ensure adequate and appropriate levels of service are dispatched for non-emergency ambulance transports and other requests for service.
- Reconcile paperwork between Dispatch and crews to ensure appropriate records are in place for all required encounters including patient transports, refusals of medical care, treatment without transport, standbys, and all other required ambulance or out-of-hospital business requests.
- Reconciliation will occur through the Crew End of Shift Checkout Process as well as electronic PCR reconciliation programs including Web Recon and MMR.
- Review trailing documents such as the hospital face sheet, EKG strips, PCS form, etc. for appropriate inclusion in the patient care report as well as completeness and accuracy.
- Review patient or representative signatures for completeness and compliance with the AMR Signature Policy.
- Receive real-time notification when certain issues exist (missing patient signatures, missing PCS forms, destination mismatching, etc.) so communication with crews can occur while they are still on shift to prevent a delay in receiving appropriate documentation.
- Reconcile ambulance trips in Jaguar ensuring every billable ambulance request has a complete and thorough PCR.
- Monitor and actively work the Checkpoint queues of assigned Operations as the trips are captured in Checkpoint.
- Review patient demographic information including name, address, and phone number, date of birth, insurance information, etc. to ensure complete and accurate data.
- Search approved systems for additional patient demographics and insurance information to reinforce crew-captured data.
- Searched the Jaguar billing system for pre-existing accounts related to the Pre-Billing Specialist's system.
- Updated existing accounts or created new accounts to ensure accurate patient records.
- Provided timely feedback to crews on documentation adequacy of ambulance or out-of-hospital service requests, improving compliance.
- Feedback may include specific information relating to an individual PCR or statistics identifying overall performance of crewmembers.
- Additionally, feedback may be provided to the Pre-Billing Supervisor regarding coding and PBS information received after the trips have been sent to PBS for billing.
- Develop and sustain excellent working relationships with AMR professionals (e.g., Operations, PBS, Business Development, IT and Finance), as well as with the Company’s clients, payers, consultants, banks and financial intermediaries and government agencies.
Business/Claims Analyst
Health Net through North Highland
Rancho Cordova, USA
11.2015 - 05.2016
- Identifies, evaluates and documents business needs and objectives, operational processes and procedures, problems and requirements.
- Represented business specialty on formal project teams, gathering and analyzing data, defining business specifications, and documenting business processes.
- Recommended operational and process improvements leveraging efficiencies and available technologies.
- Maintains a repository of performance metrics, and generates management reports illustrating statistical data, text and graphics.
- Researched, planned, prepared status reports, and wrote project documentation.
- Produced comprehensive documentation including project plans, analytical reports, decision backups, and training plans to support project objectives and stakeholder needs.
- Conducts secondary research using a variety of publications, services and health statistic databases.
Medical Bill Review Analyst
Sacramento Pediatric Gastroenterology
Sacramento, USA
09.2014 - 10.2015
- Reviewed and appealed unpaid and denied claims to secure rightful payments.
- Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid.
- Follow up on unpaid claims within standard billing cycle timeframe.
- Submitted technical and professional medical claims to all insurance companies in a timely manner.
- Coded data to produce and submit claims to insurance companies.
- Checked insurance payments for accuracy and compliance with contract discounts to ensure proper reimbursements.
- Identify and bill secondary or tertiary insurances.
- Review patient bills for accuracy and completeness and obtain any missing information.
- Maintained comprehensive knowledge of insurance guidelines, particularly Medicare and Medi-Cal, to ensure compliance.
- Reviewed all accounts for insurance or patient follow-up.
- Managed collections for unpaid accounts through direct communication with patients.
- Answer all patient or insurance telephone inquiries pertaining to assigned accounts.
- Call insurance companies regarding any discrepancy in payments if necessary.
- Handled all insurance contracts and re-negotiation proposals.
- Research included all pertinent documentation to comply with all applicable reporting requirements.
- Processed grievances and appeals in compliance with state regulations and insurance policies to uphold member rights.
- Mediator between both members and providers in order to provide satisfactory resolution’s to complaints against services or treatment received.
- Communicated verbally and in writing with members and providers to collect and research relevant documents and background information.
- Review members' case file to determine if representative/appellant is authorized party and if complaint is valid.
- Conducted investigate of issue, research, and collected all information necessary for a determination to be made.
- Notified member of outcome within a turn-around-time defined by all applicable regulations.
- Work all Patient Financial Estimates for collection of patient responsibility for procedures and upcoming appointments, which includes co-payments, deductibles, coinsurance and non-covered services.
- Met all turnaround times for assigned cases.
- Managing the facility’s Accounts Receivable reports.
- Met all turnaround times for assigned cases.
Medical Bill Review Analyst
Sierra Nevada Memorial Hospital through GetixHealth (formerly ACS/Xerox)
Grass Valley, USA
02.2005 - 05.2014
- Performs analyses and manages the day-to-day operations of the patient billing process.
- Review & analyze each billing cycle to ensure accuracy.
- Researched and resolved billing issues to enhance accuracy and compliance.
- Evaluated patient financial assistance applications submitted for hospital services and obtained supporting documentation.
- Process billing for commercial and government payers.
- Obtain supporting documentation, i.e., medical records, EOBs, authorizations, referrals, etc.
- Review, interpret and apply contractual terms.
- Identify and / or apply contractual and administrative adjustments.
- Investigated irregularities and recommended corrective measures to improve billing processes.
- Coordinates the appeals process with other departments, including, Clinical Provider Appeals, Claims Adjustments and the Customer Contact Centers.
- Processed grievances and appeals in compliance with State Regulatory entities, Insurance and outlined policies and procedures.
- Mediator between both members and providers in order to provide satisfactory resolutions to complaints against services or treatment received.
- Research included all pertinent documentation to comply with all applicable reporting requirements.
- Notified member of outcome within a turn-around-time defined by all applicable regulations.
- Review members' case file to determine if representative/appellant is authorized party and if complaint is valid.
- Conducted investigate of issue, research, and collected all information necessary for a determination to be made.
- Communicated both verbally and in writing with Members, Providers, and others, as necessary, to collect and research all relevant documents and background information, and provide oral notifications of resolution.
- Coordinates with internal and external resources to ensure a timely and appropriate resolution of appeal cases.
- Manages caseload efficiently.
- Coordinates the clinical review of administrative provider appeals and other cases as assigned.
- Analyzed third-party liability, WCAB, and health insurance billing contracts to ensure compliance.
- Medical collection account activities and working directly with Collection Agencies to resolve accounts, along with working debtor disputes.
- Process accounts receivable monthly invoices, maintain contract and billing files as well review open A/R balances.
- Audit and resolve accounts on billing reports in a timely manner.
Education
College level course work - arithmetic, communication, analytical skills
Woodland Community College
WoodlandSkills
- Medical Billing
- Collections
- Insurance
- Account Management
- Financial Services
- EPIC
- CareCloud
- MediTech
- IBAX
- Allegra
- Jaguar
- MS Office
References
Available Upon Request
Timeline
Pre-Billing Specialist/Transfer Coordinator/Dispatcher
American Medical Response (AMR)/CALSTRS/REACH (GMR)
05.2016 - 08.2025
Business/Claims Analyst
Health Net through North Highland
11.2015 - 05.2016
Medical Bill Review Analyst
Sacramento Pediatric Gastroenterology
09.2014 - 10.2015
Medical Bill Review Analyst
Sierra Nevada Memorial Hospital through GetixHealth (formerly ACS/Xerox)
02.2005 - 05.2014
College level course work - arithmetic, communication, analytical skills
Woodland Community College