Lisa Marie Jimenez

Prepared itemized statements, bills, or invoices and recorded amounts due for services rendered. Processed and delivered accurate and timely invoices to clients by managing monthly billing cycles to ensure timely issuance of invoices and statements. Researched unbilled revenue and resolved billing inconsistencies and errors. Analyzed and completed variance reports and collaborated with Partners to research and resolve billing discrepancies to enable accurate billing. Increased revenue retention by setting up follow-up system for outstanding payments. Worked with multiple service departments to check proper billing information to resolve complex billing issues, promoting teamwork and knowledge sharing within the department. Collaborated with the accounts receivable team to recover payments, maintaining cash flow and minimizing write-offs.Contributed to improved financial reporting by reconciling discrepancies between invoiced amounts and actual payments received. Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.

Ensure that all client accounts are properly and completely documented with the department’s documentation requirements established by management. Promote client loyalty and retention through quality Customer Service and quick resolutions to ensure that excellent customer service was delivered through communication and coordinating with other departments to resolve issues. Validate both facility and physician claims for all billable clients in system and all pertinent billing information on UB and HCFA to submit clean claims to clearing house. Cross reference Physician Name and Dates of Service with the financial log for accuracy on all UB and HCFA claims and all CPT, HCPCS and diagnosis codes with the coding sheet for accuracy on all UB and HCFA claims. Ensure all clients demographics and payer information are accurate for claims submission. Access Daily Claims Report to ensure everything was billed and work rejections if needed. Bill Secondary claims with Primary EOB. Work and resubmit corrected claims as needed and notate accounts accordingly. Receives denied claims to research appropriate appeal steps which is to communicate directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, and adjustments. Works with the payors to negotiate contract pay rates for denials and prevent low payments so that profit can increase for future claims.

Responsible for reviewing and ensuring proper reimbursement and revenue capture of medical services and coding. Ensured that the accounts audited reflect proper documentation, charges, coding, billing and payment. Worked closely with clinical departments to ensure proper charge capture and complete documentation and coding are in accordance with appropriate payer source. Responsible for account/chart research to resolve claim edits, claim denials, and coding corrections for services. Participates in the build and testing of charging systems. Review/Audit patient disputes surrounding inappropriate coding in a timely manner. Review/Audit insurance denials related to coding questions in a timely manner, providing remedy as needed. Assist in verifying and correcting coding issues per the insurance request or claim denials. Identify areas of coding weakness and develop resolution plans to address with clinical team, laboratory vendors, and patients. Assist in the identification of new workflow processes that will improve departmental efficiency. Work closely Revenue Cycle IT to resolve technology issues regarding charge capture, claim denials, and coding. Responsible for maintaining current ICD-9, ICD-10, CPT and coding skills. Perform internal quality assurance - summarize findings and report these to clinical and revenue team.

Schedule patients for clinic and surgery. Answered multi-phone lines, and excellent customer service skills. Check-in and Check-out patients. Process co-payments, co-insurance and deductibles. Resolve patient’s accounts. Participated in ongoing training programs related to HIPAA compliance, maintaining up-to-date knowledge on regulatory requirements. Verified insurance eligibility and coverage for patients. Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic. Filed and maintained patient records in accordance with HIPAA regulations.

Coordinate with the receptionist to ensure performance standards within the offices. Prepare ledgers from accounts to collect balances owed for patients seen at time of service. Communicated with departments to resolve patient accounts. Consulted with appeals specialists regarding missed denials for claims generation. Reconcile all batches from medical and optical offices daily, weekly, and monthly. Reviewed batches for accurate collections of balanced deposit each day. Ensure payments were collected and applied to accounts accordingly. Resolved credit balances for all patients accounts. Ensure all charges were entered and billed for all patients seen at time of service. Consult with appropriate department staff on missing information or errors in posting. Maintain necessary office supplies. Answer patient and client phone calls in a professional manner.

• Payment Poster for Main and Ambulatory Center

Posting of medical and guarantor payments from insurance companies manually and electronically. Balanced all posted payments and reviewed accounts for any errors by generating necessary reports. Generate reports to identify outstanding credit balances. Process refunds and credit balances. Reviewed write-off report to identify incorrect adjustments.

• Patient Account Representative

Processed and followed up on insurance claims for main and surgery center company. Identified problem accounts with denials and incorrect write-offs to decrease trends. Investigates and corrects errors with denials and missing information needed. Resolved system reports such as aged accounts and unallocated payments. Processed co-payments, co-insurance and deductibles. Compose correspondence, memos and letters for medical documentation for claim appeals. Prepared statements, bills and invoices. Answer patient and client phone calls in a professional manner. Provided effective training to team members to meet performance standards

Directed patients to exam rooms, obtained client medical history, medication information, symptoms, and allergies, and prepared for physician examinations. Managed multi-line phone system and pleasantly greeted patients. Checked patient insurance, demographics, and health history to keep information current and accurate. Scanned identification and insurance cards. Coordinated patient scheduling, check-in, check-out, and payments for billing. Expedited lab results retrieval. Coordinated referral processes, effectively liaising between patients, providers, and specialists for seamless care transitions. Performed various administrative tasks by filing, copying and faxing documents. Adhered to strict HIPAA guidelines to protect patient privacy.

Directed patients to exam rooms, obtained client medical history, medication information, symptoms, and allergies, and prepared for physician examinations. Administered medications and injections as prescribed, adhering strictly to protocols for patient safety. Assisted with medical procedures as needed, ensuring a smooth flow of daily operations in the clinic. Coordinated referral processes, effectively liaising between patients, providers, and specialists for seamless care transitions. Performed various administrative tasks by filing, copying and faxing documents. Adhered to strict HIPAA guidelines to protect patient privacy.

Directed patients to exam rooms, obtained client medical history, medication information, symptoms, and allergies, and prepared for physician examinations.Administered medications and injections as prescribed, adhering strictly to protocols for patient safety. Assisted with medical procedures as needed, ensuring a smooth flow of daily operations in the clinic. Managed multi-line phone system and pleasantly greeted patients. Checked patient insurance, demographics, and health history to keep information current and accurate. Scanned identification and insurance cards. Coordinated patient scheduling, check-in, check-out, and payments for billing. Expedited lab results retrieval. Coordinated referral processes, effectively liaising between patients, providers, and specialists for seamless care transitions. Performed various administrative tasks by filing, copying and faxing documents. Adhered to strict HIPAA guidelines to protect patient privacy.