Lillian Rodriguez

Managed billing for five high-volume hospitals, ensuring timely reimbursement for inpatient and outpatient claims.

Audited and edited claims to facilitate prompt payments from Medi-Cal Managed Care payors.

Conducted eligibility checks via insurance portals and searched for authorizations in revenue cycle systems.

Identified discrepancies in inpatient and outpatient claims to enhance billing accuracy.

Processed crossover and secondary billing to maximize revenue recovery.

Submitted accounts for corrections regarding invalid APR DRG, diagnoses, procedure dates, and HCPCS codes.

• Handle complex inpatient claims, including split billing for acute/admin services across multiple MCPs.
• Utilized Optum Assurance Reimbursement Management system to optimize revenue cycle management.

• Responsible for all aspects related to insurance claims to maximize revenue streams.
• Provided tenacious follow-up to ensure proper payments were fully collected.
• Followed up on timely filing on all claims as needed under strict deadlines
• Responsible for analyzing claims and filling secondary claims as needed
• Audited all commercial and Medi - Medi claims
• Verified insurance Eligibility, contact with both patient and payors
• Research and resolve incorrect payments, EOB rejections and other issues with outstanding balances.
• Proficiency in Muli-tasking when managing administrative work and ensuring top level patient care and support.

• Implemented clients on AdvancedMD billing software, trained all new clients (physicians, nurses, front/back end staff, billers, administration staff) via Go To Meeting
• All trainings where broken up into milestones dependent on the role of the staff that was being trained, all trainings were tailored to the need of the specialty of each practice
• Some clients were well versed in practice for many years as well as clients opening up private practices
• Helped clients with questions and or concerns with HIPPA, EDI Agreements, Insurance Carriers, Clearing House, Collecting Monies ( copays, patient responsibilities) running reports for end of day, collections.

• Responsible in overseeing the Billing Department for 5 Specialty clinics with the only payer accepted was commercial insurance, supervise and assure Billing coordinators were adequately trained to bill and challenge denied claims
• Improved revenue for all clinics, Extensive audits and provide patients with a better understanding of PR's, post and reconcile insurance and patient payments , Research and resolve incorrect payments, EOB rejections Denials resolve other issues with outstanding accounts
• Submission of secondary payor claims upon processing of primary insurance
• Follow up on insurance and patient aging
• Re-Submit insurance claims as necessary
• Knowledgeable in timely filing restrictions
• Properly handle escalated supervise calls
• Responsible for creating Standard Operating Procedures
• Responsible for interviews and hiring for department.