Summary
Overview
Work History
Education
Skills
Timeline
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LINET TOLO

Nashville,TN

Summary

Seasoned Claims Analyst with a proven track record adept in accounts receivable and complex problem resolution. Demonstrates exceptional auditing skills and interpersonal communication, driving process optimization and compliance. Achieved significant improvements in billing accuracy and efficiency, showcasing strong problem-solving abilities and team-building expertise.

Overview

13
13
years of professional experience

Work History

Billing Analyst

Corrohealth
05.2024 - Current
  • Performs day to day billing and follow up on most insurance carriers
  • Document claims billed, paid, rejected and adjust claims accordingly
  • Appeal claims, attach medical records and submit either electronic or by mail
  • Identifies and escalates issues affecting accurate billing and follow up activities
  • Adheres to proactive practices including contacting the payers directly for payment
  • Assist in special projects whenever needed
  • Follows up on overpayments and underpayments
  • Provides problem solving resolutions to billing and completes weekly goals

Senior Quality Auditor

Aetna
05.2023 - 03.2024
  • Review claims thoroughly to assess the adequacy of root cause analysis and preventive actions
  • Conduct audits on claims to guarantee accurate claim adjudication
  • Review patient accounts for trends that indicate where additional assistance might be needed
  • Accurately prepare, review, and submit claims timely to various insurance companies
  • Research, reviews and initiates the resolution of billing errors
  • Review and analyze audit data, including trend results with recommendation of process changes and refresher training
  • Document findings related to audits performed daily and ensures claims are paid according to provider contracts
  • Running access queries as needed for administrative purposes

Billing Coordinator

American Physician Partners
Brentwood, TN
09.2018 - 04.2023
  • Managed and resolved complex billing exceptions, also cross trained in other departments
  • Charge entry, review diagnosis codes and procedure codes
  • Patient demographics, verified insurance coverage, changes with appropriate documentation
  • Billed electronic claims, analyzed rejected, outstanding and denied claims
  • Reviewed explanation of benefits, process and mailed paper claims
  • Communicates with appropriate hospital departments to clarify billing discrepancies
  • Identified and resolved patient billing complaints or any claims issues
  • Appealed claims in a timely manner, documented and attached medical records
  • Monitored accounts receivables and responded as needed

Medicare Analyst

DVCR
Brentwood, TN
12.2011 - 08.2018
  • Responsible for 14 facilities, worked very closely with all the Business Office Managers
  • Billed all Medicare claims, monitors claims processing, work all the return to provider claims
  • Adjusts bills and forward the denials to the appeals department
  • Submit the Medicare Quarterly Credits balance report
  • Very detailed and works with a high degree of accuracy and outstanding problem-solving skills
  • Collaborate with other departments to gather necessary documentation
  • Communicates with appropriate hospital departments to clarify billing discrepancies
  • Comprehends SNF billing information and adheres to CMS guidelines
  • Knowledge of regulatory requirements HIPAA, EMR, Health industry standards

Education

Some College (No Degree) -

The University of Texas At Arlington
Arlington, TX

Skills

  • Accounts receivable
  • Problem-solving skills
  • Complex problem resolution
  • Privacy initiatives
  • Interpersonal and verbal communication
  • Auditing
  • Team building
  • Compliance
  • Process Optimization Recommendations

Timeline

Billing Analyst

Corrohealth
05.2024 - Current

Senior Quality Auditor

Aetna
05.2023 - 03.2024

Billing Coordinator

American Physician Partners
09.2018 - 04.2023

Medicare Analyst

DVCR
12.2011 - 08.2018

Some College (No Degree) -

The University of Texas At Arlington

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LINET TOLO