Liliana Hernandez
Fontana,CA
Summary
Revenue Cycle Professional with over ten years of experience in Revenue Cycle Operations. Demonstrated success in supporting and enhancing revenue cycles for Hospital and PCP facilities. Knowledgeable about debt management, collections policies and insurance payments. Well-qualified Medical Billing Specialist proficient in CPT, HCPCS , ICD-10 coding and EPIC. Researches tirelessly using latest technology and decisively guides clients in financially sound directions. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. I am interested to seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
13
13
years of professional experience
1
1
Certification
Work History
FQHC Coordinator
UCI Health
03.2019 - Current
- Coordinator of daily operations of the FQHC billing and collections department
- Gathered and organized materials to support operations.
- Mentor/Trainer to billing and collections team; , manage team productivity, quality review reporting and auditing, provide training and coaching for employees, manage time and attendance
- Coordinated with human resources department to handle payroll and personnel databases.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Coordinated individual duties after careful evaluation of each employee's skill level and knowledge.
- Denials management and auditing trending to ensure appropriate actions in order to decrease monthly denials
- Work alongside various departments in order to accurately comply with billing regulations Revenue Integrity, Registration/Auth Coordination, HIM, Clinic Executive Leadership and Revenue Cycle Sr Management
- Provide feedback and training to providers in order to charge correct CPT, ICD10 codes and follow strict billing guidelines for Medicare, Managed Medicare, Medi-cal, Managed Medi-cal and Commercial/Managed Care payers
- Research data, perform analysis of AR inventory and provide resolution when trends are found that entail increases
- Reporting of revenue and inventory to management for monthly auditing and reporting to finance and budget units
- Implemented project management techniques to overcome obstacles and increase team productivity.
- Work with systems analyst to ensure EPIC system is working properly for FQHC accounts
- Maintains up-to-date knowledge of all the operations and the business requirements of the department with a focus on payer requirements/contracts/guidelines
- Prepare and review reports from Cirius and Epic for account management of all levels from billing and collections to auditing and research
- Assist team when complex accounts require more in-depth review, escalate matters to payers
- Maintain assigned EPIC work queues to resolve or escalate accounts
- Used job-related software to draft and finalize written correspondence and documentation.
- Open service request tickets for all levels of requests, solving system/account problems, system development/changes, payer requirement implantation
- Work along side various departments such as Analytics /IT, Contracting and Compliance to ensure EPIC implementation
- Collected and analyzed business data from various departments to prepare reports and presentations for management.
- Set priorities and problem-solved workflow issues to maintain rapport with customers and managers.
- Tracked records, filed documents and maintained communication between clients to manage office activities.
- Participated in workshops and in-service meetings to enhance personal growth and professional development.
Biller IV Lead
UCI Health
09.2016 - 03.2019
- Resource to the team, training and assisting with billing and collections of inpatient and outpatient accounts
- Assist in updating staff and other departments on Medi-cal and Managed Medi-cal policies
- Review and keep up to date with payer contracts/guidelines/requirements for billing or follow up
- Open RFS to resolve billing and collections issues or to meet payer guidelines
- Prepares productivity and QR reports for supervisor review
- Prepares Medi-cal, Managed Medi-cal weekly check write for reporting to management
- Prepare and review reports from Cirius and Epic to identify trends on accounts with billing and collections issues to find resolution
- Prepare reports for staff to target accounts that require immediate attention
- Assist team to comply with exclusion billing and follow up to payers
- Assist team when complex accounts require more in-depth attention
- Prepare upload files to adjust accounts in which representatives have complied with collection efforts
- Maintain assigned EPIC work queues to resolve or escalate accounts
- Maintain Managed Medi-Cal accounts up to date on clinical appeals log/denial pay report
Biller
Rx Transcription and Coding
06.2015 - 09.2016
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Daily outpatient physician and ASC billing to commercial workers compensation, government, and personal injury insurance
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Adhered to established standards to safeguard patients' health information.
- Delivered timely and accurate charge submissions.
- Daily payment posting of Medicare, Medi-cal, Workers Compensation, Personal Injury and Commercial Payers
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Commercial and Non-Commercial payer denials review
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Audited and corrected billing and posting documents for accuracy.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Handled account payments and provided information regarding outstanding balances.
- Generated monthly billing and posting reports for management review.
- Monthly/Weekly reconciliation reports for clients
- Review that coding is accurate on claim, and review for correction, correct when needed
- Entering of charges, work closely with coders to bill correct CPT, ICD-10 and per Medicare guidelines
Collections Representative-Biller
UCLA Health System
04.2010 - 06.2015
- Daily inpatient and outpatient billing to commercial payers, hard copy on UB-04 form and via electronic submission
- Payer Authorization verification to bill accurately
- Comply with HIPAA regulations
- Verified insurance of patients to determine eligibility.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Adhered to established standards to safeguard patients' health information.
- Follow up with payers for payment and non-payment issues
- Delivered timely and accurate charge submissions.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Audited and corrected billing and posting documents for accuracy.
- Generated monthly billing and posting reports for management review.
- Perform collections follow up on issue accounts
- Workers comp billing to payers along with required reports
Education
Certificate - Medical Billing
American Career College
Ontario03.2009
Skills
- Expert knowledge of billing forms; UB-04 CMS 1500
- CPT
- HCPCS
- ICD-10
- Medical and Insurance terminology
- Hospital, Primary Care Billing and Collections,
- Denials Management
- Effective Written and Verbal Communication skills
- Medi-cal, Managed Medi-cal, Medicare, Managed Medicare and Commercial Payers
- Independent and Team Player, working with Staff and Management
- Effective analytical skills,
- Problem solving and critical thinker
- Excellent Organization Skills
- EPIC Knowledge
- Project Management
- Revenue Cycle Operations
- CMS Guidelines
- Health Access Programs
- Analyze Financial Records
- Revenue Cycle Management
- Revenue Monitoring
- Medicare Regulation
- Financial Data Analysis
- System Updates
- HIPAA Regulations
- Revenue Cycle Process Improvements
- Insurance Terminology
- Data Verification
- Account Reconciliation
- Revenue Operations
- Risk Identification
Certification
AAPC May 2023
Certified Professional Coder
Timeline
FQHC Coordinator
UCI Health
03.2019 - Current
Biller IV Lead
UCI Health
09.2016 - 03.2019
Biller
Rx Transcription and Coding
06.2015 - 09.2016
Collections Representative-Biller
UCLA Health System
04.2010 - 06.2015
Certificate - Medical Billing
American Career College
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