Lesly C Yanes
Hialeah
Summary
Motivated and proactive professional with 20 years of experience working in the healthcare field in the area of Managed Care and financial assessment with different insurance companies as well as patient billing following all healthcare regulations. Ability to work in fast-paced work environments with minimal supervision. Strong attention to detail, self-discipline, analytical and logical thinking. Excellent people skills and thrives on helping to solve problems. Highly persistent and determine to guide others.
Overview
20
20
years of professional experience
Work History
Billing Specialist
Ensemble Health Partners
05.2022 - Current
- Preparation and review of the claim status rejection report (277) in the SSI system and its submission to Billing Manager for final approval.
- Review and validated claims electronically in SSI system to payers.
- Works diligently in EIQ system in order to complete all requests receive from the different departments within the hospital.
- Responsible of the billing correction that includes edit failure, late charges, and NCH ambulatory accounts.
- Correction of insurance registration in the PEDS system as well as the review of patient’s insurance eligibility.
Billing Coordinator
Nicklaus Children's Hospital
07.2006 - 05.2022
- Performs daily billing functions, including but not limited to claims translation, daily claims transmission, receiving updates, retrieving payer reports, and retrieving payer error reports.
- Edits downloaded claims in the electronic billing system and determines billing status based upon third party requirements and hospital guidelines.
- Transmits edited claims to appropriate third party payers.
- Assists in Training hospital employees on the use of the billing system.
- Billing secondary insurance EIP (Medicaid part C) as well as posting of EIP (Early Intervention Program) payments on accounts accordingly.
- Prepare billing packages from the nine hospital centers to send to EIP.
- Inputs information into the hospital computer system to reflect daily activity on patient accounts when necessary and ensures the accuracy of such input.
- Correction of all claim errors for I/P and O/P accounts and review of hold accounts by alphabet order.
- Work pending accounts for Medicaid eligibility (I/P and O/P) accounts update.
- Send emails to the appropriated centers if authorizations needed.
- Works closely with the Audit Integrity Department in systematic correction of payer.
- Review and resolve EIP complaints for balance pending.
Customer Service Representative
Nicklaus Children's Hospital
08.2005 - 06.2006
- Provided general customer service to patient parents.
- Scanned and verified if patient insurance information was current by accessing insurances websites.
- Collection of patient payments over the phone.
- Arrange monthly payment plan agreement for patient parents.
- Assist parents to complete financial evaluation form.
Patient Access Register
Nicklaus Children's Hospital
05.2005 - 07.2005
- Greet parents and families on the telephone, displaying excellent customer service skills.
- Interview parents to obtain proper demographic information such as financial and medical information in order to pre-register or pre-admit the patients for upcoming treatment.
- Notify patient's family member of any co-payments, deductibles or out of-Pocket expenses not covered by their insurance company.
- Obtain and validates prescription when appropriate.
- Verify third party payer’s information, using their websites or by telephone.
- Seeking appropriate insurance authorization for hospital services when required.
Education
Certified Revenue Cycle Representative-HFMA - CRCR
Ensemble
Miami, FL01.2022
Accredited Claim Adjuster License#P00675 -
Miami Dade College
Miami, FL01.2005
Medical Administration Specialist -
New Professional Technical Institute
Miami, FL01.2003
Executive Secretary -
Honduras Institute of American Culture
Tegucigalpa, D.C.01.1989
Skills
- Microsoft Office
- Pivot Tables
- VLOOKUP
- IF Functions
- Word
- Outlook
- PowerPoint
- CPT
- HCPCS
- Revenue codes
- Cerner
- AS400
- Power chart
- Managed care billing
- Reimbursement methodologies
- Medical terminology
- Microfilm machine viewing
- Indexing
- Communication skills
- Verbal communication
- Written communication
- People skills
- Problem-solving
Timeline
Billing Specialist
Ensemble Health Partners
05.2022 - Current
Billing Coordinator
Nicklaus Children's Hospital
07.2006 - 05.2022
Customer Service Representative
Nicklaus Children's Hospital
08.2005 - 06.2006
Patient Access Register
Nicklaus Children's Hospital
05.2005 - 07.2005
Accredited Claim Adjuster License#P00675 -
Miami Dade College
Medical Administration Specialist -
New Professional Technical Institute
Executive Secretary -
Honduras Institute of American Culture
Certified Revenue Cycle Representative-HFMA - CRCR
Ensemble
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