LISA SAN MIGUEL -PEREZ

• Responsible for managing and overseeing all aspects of billing and collections process and provides leadership and technical expertise to staff and assists Revenue Cycle Director with leadership and departmental tasks as delegated
• Oversight and implementation of policies and procedures for department
• Manages staff schedule and time off requests
• Trains, leads and mentors new and current staff
• Contributes to development of billing staff by being resource of knowledge and Provides initial 'point of contact' for team when lead is out
• Acts as liaison between Revenue Cycle Director and billing staff
• Coordinates with Revenue Cycle Director regarding all problems/issues related to operations and provides practical solutions
• Oversee collections process to ensure collections targets
• Conduct performance reviews on assigned staff quarterly and provides feedback to assigned staff
• Addresses assigned departmental issues and concerns
• Assist and offer process improvements and best practices
• Provides suggestions to Director of Revenue Cycle on team goals and communicates those goals to billing team
• Participates in and assists with development of operational metrics and dashboards for respective team
• Oversees staff 'real time' charge entry to ensure proper coding; make adjustments as required
• Assists physician teams/department staff with billing and collections efforts
• Responsible for claims clearance through corrections, appeals and/or resubmissions
• Monitor, track, and trend claim denials while offering guidance and solutions to meet denial percentage goals
• Conduct and participate in monthly denial meetings with Revenue Cycle Director and Revenue Cycle Coordinator
• Creates, maintains, and analyzes reports as directed by Revenue Cycle Director
• Works with individual department co-workers on special projects as requested by Revenue Cycle Director
• Manage credentialing data for all healthcare providers, including maintaining accurate and up-to-date provider information, credentials, and certifications
• Worked with customers to develop payment plans and bring accounts current.
• Reviewed billing problems, researched issues, and resolved concerns.

Applies known insurance guidelines to ensure clean claim submission

• Anticipates potential billing/reimbursement problems and takes measures to prevent them
• Reviews and monitors 20-30 accounts within accounts receivable system, determines and performs appropriate collection efforts to resolve account, to include follow-up online, by phone and written correspondence
• Processed appeals and performs reimbursement analysis as directed by Billing Manager
• Corrects denied submission and denied claims in timely manner and notes invoice accordingly
• Responded to patient, family, and external payer inquiries
• Worked with outside entities to resolve issues with billing, claims and payments
• Collaborated with customer to create debt repayment plan based on current financial condition
• Entered client details and notes into system for interdepartmental access and review.

• Responsible for day-to-day management of medical office
• Supervised office staff
• Manage HR responsibilities such as interviewing, hiring, disciplinary process, and employee reviews
• Maintain personnel files
• Experience with ICD-10, CPT, and HCPS
• Experience in scheduling patient appointments and testing for patients
• Custodian of patient records and all HIPPA forms
• Excellent customer service experience
• Manage office supplies inventory
• Acquire prior authorizations from insurance for MRI, CT, and medications
• Maintain patient information for State Vaccine Reports, Income Reports, and statistics with balancing daily schedule
• Process patient statements and reimbursement claims
• Manage and respond to all queries in person, by phone or in writing
• Process employee payroll and all state/local tax forms
• Managed physician's personal calendar and scheduled events
• Daily bank deposits
• Balancing/reconcile bank statements at end of every month
• Balance petty cash box and credit cards daily
• Communicated with insurance providers to resolve denied claims and resubmitted
• Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies
• Delivered timely and accurate charge submissions
• Collected payments and applied to patient accounts
• Set up and maintained new electronic billing system
• Gathered information from multiple sources to simplify billing and organize accounts
• Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers
• Trained new employees on multiple medical billing programs and data entry software
• Filed and updated patient information and medical records.

• Posted all daily charges and sent electronically
• Worked with ICD-9 and CPT codes
• Worked all outstanding accounts on day-to-day basis
• Answered customers queries, complaints, and problems
• Experience in filing and answering multi-line phone system
• Communicated with insurance providers to resolve denied claims and resubmitted
• Filed and updated patient information and medical records
• Delivered timely and accurate charge submissions
• Adhered to established standards to safeguard patients' health information
• Reviewed patient diagnosis codes to verify accuracy and completeness
• Gathered information from multiple sources to simplify billing and organize accounts
• Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.