Lauren Valdez
Plumas Lake,CA
Summary
Experienced and detail-oriented medical billing and coding specialist with a strong background in revenue cycle management, insurance claim processing, and patient account reconciliation. Adept at identifying and resolving billing discrepancies to maximize efficiency, ensure regulatory compliance, and optimize cash flow. Skilled in ICD-10-CM, CPT, HCPCS coding, Medisoft, and Epic software. Passionate about driving operational excellence and maintaining strong relationships with providers, patients, and insurance companies.
Knowledgeable Desired Position with robust background in medical billing and coding. Proven track record of accurately processing and managing patient billing information, resulting in improved revenue cycles. Demonstrated proficiency in claim submissions and resolution, leveraging strong attention to detail and organizational skills.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Medical Billing Specialist
California Sleep Solutions
08.2020 - Current
- Directed billing activities for Durable Medical Equipment, ensuring alignment with payer-specific standards.
- Review provider documentation to determine accurate principal diagnosis and claim eligibility.
- Serve as the primary liaison between patients, Managed Care Plans, and internal departments, addressing billing inquiries and claim disputes.
- Maintain and enhance relationships with physicians, staff, and external partners to streamline operations.
- Utilize Medisoft software for claims processing and payment reconciliation, reducing errors and improving efficiency.
- Led claims projects, ensuring timely reimbursement and minimizing denials.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Located errors and promptly refiled rejected claims.
- Identified and resolved patient billing and payment issues.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Collected payments and applied to patient accounts.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Precisely evaluated and verified benefits and eligibility.
- Filed and updated patient information and medical records.
- Served as a subject matter expert on medical billing matters, providing guidance to colleagues on complex cases or unique situations.
- Participated in departmental meetings, sharing insights and ideas for improving overall medical billing efficiency and revenue generation.
- Reduced errors in medical billing by meticulously reviewing patient records and ensuring accurate coding.
- Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
Medical Billing Specialist & Account Reconciliation
Medical Vision Technology
03.2023 - 05.2024
- Managed billing requirements for all surgical procedures and evaluation & management services.
- Performed account reconciliation, identifying and resolving discrepancies to ensure accurate financial reporting.
- Conducted root cause analysis to diagnose billing issues, implementing corrective actions to enhance revenue cycle performance.
- Utilized Epic software to efficiently manage patient records, process claims, and streamline revenue cycle workflows.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Identified and resolved patient billing and payment issues.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Collected payments and applied to patient accounts.
- Efficiently processed refunds or adjustments for patients when necessary, ensuring accuracy and compliance with company policies.
- Conducted regular audits of patient accounts for potential underpayments or overpayments due to incorrect coding or billing practices.
- Posted payments and collections on regular basis.
National Hiring Manager
Symmetry Financial Group
10.2018 - 02.2019
- Recruited candidates using targeted prospecting.
- Monitored key recruitment metrics, including call volume, applicant flow, and retention rates, to drive hiring efficiency.
- Ensured seamless communication throughout the recruitment process to enhance the candidate experience.
- Conducted phone interviews to assess applicants relevant knowledge, skills, experience and aptitudes.
- Customized wording of job profiles, social media techniques, and website subscriptions.
Teller & Customer Service Representative
Wells Fargo Bank
San Rafael, CA
09.2015 - 07.2018
- Processed financial transactions in accordance with audit procedures.
- Resolved client inquiries to ensure seamless communication.
- Balanced cash drawer daily and resolved discrepancies to provide accurate data regarding cash flow.
- Processed customer transactions promptly, minimizing wait times.
- Promoted a welcoming atmosphere in the branch by greeting customers warmly upon arrival and addressing them by name when possible.
- Answered customer inquiries regarding account balances, transaction history, services charges, and interest rates.
- Developed strong relationships with customers through exceptional service, fostering loyalty and trust.
- Increased cross-selling opportunities by identifying customer needs and recommending appropriate banking products or services.
- Monitored and reported suspicious activity in line with bank security policies.
- Provided training to new tellers on bank procedures, systems, and customer service best practices.
- Reduced queue times during peak hours with effective cash handling and prompt service.
- Increased customer satisfaction through friendly interactions and resolving issues promptly.
CNA Caregiver
Hired Hands Homecare
Novato, CA
10.2014 - 11.2015
- Provided compassionate patient care, including medication administration and vital sign monitoring under healthcare practitioner supervision.
- Engaged patients in activities and provided transportation, fostering social interaction and well-being.
- Encouraged patient independence through assistance with everyday activities.
- Promoted good oral and personal hygiene by aiding patients with shaving, bathing, and teeth brushing.
- Enhanced patient satisfaction by providing compassionate and attentive care.
- Utilized proper body mechanics and assistance devices when transferring patients, minimizing the risk of injury for both parties.
- Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
- Prevented bedsores by regularly repositioning patients and implementing proper wound care techniques.
- Cared for residents in assisted living facility and delivered high-quality support to meet needs.
- Cared for clients with diagnoses such as respiratory failure, diabetes, Parkinson's disease and muscular dystrophy.
- Maintained confidentiality of patient information according to HIPAA guidelines while communicating effectively with team members about critical updates.
Caregiver and Behavioral Support
Bayada Home Health
Lihue, HI
09.2010 - 09.2014
- Cleaned house, ran errands, managed laundry, and completed weekly grocery shopping.
- Assisted with dressing guidance, grooming, meal preparation, and medication reminders.
- Performed light housekeeping duties to maintain cleanliness standards while respecting the patient''s personal space.
- Maintained a safe and clean environment for patients, reducing risks and ensuring optimal health outcomes.
Restaurant Busser
Brick Oven Pizza
Kalāheo, HI
08.2008 - 09.2010
- Kept close eye on customers to quickly spot leaving guests and clear tables for future patrons.
- Enhanced customer satisfaction by ensuring tables were cleared and cleaned promptly after guests left.
- Maintained a clean and safe dining environment by sweeping floors, wiping down surfaces, and keeping walkways clear of debris.
- Assisted servers in managing their sections effectively, providing timely water refills and bread service.
- Assisted kitchen with prepping ingredients and made pizzas, salads and other food items
- Collected trash, wiped up spills, and removed trays to maintain fresh and clean customer areas.
Education
Medical Billing & Coding Professional Diploma -
MTI College
Sacramento01.2020
Associate Of General Studies - Gender Studies
Kauai Community College
Lihue, HI07.2011
Certificate - Nursing Assistant
Kauai Community College
Lihue, HI2011
Diploma -
Kauai High School
Lihue, HI10.2009
Skills
- ICD-10-CM
- CPT
- HCPCS
- Claims processing
- Denials management
- Payment reconciliation
- Epic
- Medisoft
- Regulatory requirements
- Contract analysis
- Payer-specific guidelines
- Posting adjustments
- Financial accuracy in claims processing
- Payment posting
- Claim submission
- Insurance verification
- Data entry
- Medical billing
- ICD-10
- Insurance claims
- Medical terminology
- Claims review
- Billing and collection procedures
- Insurance claims processing
- Critical thinking
- Customer service
- CMS-1500 billing forms
- Accounts receivable
- Patient collections
- Medical terminology expert
- Collection calls
- Software use
- Reimbursements
- Medical billing technology
- Account follow-up
- CPT code modifiers
- Balance reconciliation
- Payment transactions
Certification
Certified Medical Reimbursement Specialist (CMRS), AMBA, 01/01/20
Additional Information
Clinicals in a hospital, volunteering at humane society
Languages
Spanish
Elementary
Timeline
Medical Billing Specialist & Account Reconciliation
Medical Vision Technology
03.2023 - 05.2024
Medical Billing Specialist
California Sleep Solutions
08.2020 - Current
National Hiring Manager
Symmetry Financial Group
10.2018 - 02.2019
Teller & Customer Service Representative
Wells Fargo Bank
09.2015 - 07.2018
CNA Caregiver
Hired Hands Homecare
10.2014 - 11.2015
Caregiver and Behavioral Support
Bayada Home Health
09.2010 - 09.2014
Restaurant Busser
Brick Oven Pizza
08.2008 - 09.2010
Medical Billing & Coding Professional Diploma -
MTI College
Associate Of General Studies - Gender Studies
Kauai Community College
Certificate - Nursing Assistant
Kauai Community College
Diploma -
Kauai High School