Lisa Garcia
Port St Lucie,FL
Summary
Detail-oriented and methodical utilization review, billing, and credentialing in behavioral health offering 9 years of experience in related roles. Exceptional abilities in conducting research, problem-solving and prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills and superior work ethic for top job performance. Multi role positions.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Utilization Review / Billing Coordinator
ATLANTIC TREATMENT CENTER
02.2019 - Current
- Manages billing, collections, precertification, and credentialing for all lines of business in an Outpatient clinic setting
- Utilize daily, weekly, and monthly reports accordingly
- Works closely with COO to grasp all aspects of any generated income and problematic areas
- Perform monthly internal billing audits
- Provides updates regarding Insurance changes
- Insurance verification, Medicaid, Medicare and Commercial Insurance, Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing
- Verifies Insurance payments for accuracy and compliance with contract discounts
- Follow up on unpaid claims within standard billing cycle time frame
- Building internal and external relationships
- Updates Insurance contracts, obtains referrals as needed
- Reviews benefits, educates clinical staff on Insurance regulations and utilization
- Manages price negotiations with third party payors.
Utilization Review and Collections
SOUTH BEACH DETOX
02.2019 - 05.2022
- Prior authorization submission for commercial Insurance policies / Inpatient, collections
- Assisted consultant with day-to-day activities.
Utilization Review
JNL MANAGEMENT
03.2016 - 02.2019
- Provides medical records, and chart reviews
- Pre- Certification, concurrent reviews, and discharge notifications
- Use of medical terminology, experience with all lines of commercial Insurance
- Use of CPT coding and ICD10
- Verification of benefits, ability to negotiate pricing with third party vendors.
Education
Associate of Science - Respiratory Therapy
Concorde College
Miramar, United States09.2012
Skills
- Excellent verbal and written communication
- Organizational skills
- Pre-certification
- Utilization Review
- Ability to multi-task and prioritize
- CPT and ICD 10 knowledge
- Managed Care and Commercial Lines of business
- Xcel Microsoft Word
- Healthcare Reimbursement Knowledge
- Claims Processing
- Payment Posting Abilities
- Medical Terminology
- Insurance Verification
- Payer Contracts
Certification
- ASSOCIATE DEGREE - REGISTERED RESPIRATORY THERAPIST STATE OF FLORIDA, CONCORDE CAREER INSTITUTE, Miramar, FL, 09/01/12, 09/01/14
- CERTIFICATION - MEDICAL BILLING AND CODING, PENN FOSTER, Remote, 2016
Timeline
Utilization Review / Billing Coordinator
ATLANTIC TREATMENT CENTER
02.2019 - Current
Utilization Review and Collections
SOUTH BEACH DETOX
02.2019 - 05.2022
Utilization Review
JNL MANAGEMENT
03.2016 - 02.2019
Associate of Science - Respiratory Therapy
Concorde College
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