Lisa R Mercado

• Manage all MAP/MAP BASIC claims.
• Work claim errors, claim edits and claim follow up.
• Appeal denied claims.
• Correct claims and rebill.
• Communicate to my supervisor of repetitive errors, so they can be fixed by the Analyst.
• Attend monthly TEAM's meetings.
• Managed patient accounts to ensure accurate billing and timely payments.
• Improved account accuracy by updating patient information regularly.
• Reduced errors in billing by implementing precise data entry practices.
• Maintained high levels of data accuracy with meticulous attention to detail in processing insurance claims and updating patient records.
• Collaborated with interdisciplinary teams to optimize billing procedures and ensure timely reimbursements from insurance providers.
• Increased revenue recovery rates by identifying trends in denied claims, researching root causes, implementing corrective measures to prevent future occurrences accordingly.

• Oversee 14 facilities - Business Offices - Medicaid Billing Support - New Braunfels, San Marcos, Austin(multiple), Granite Mesa, and Cedar Park.
• Train Assistant Business Office Managers to bill Medicaid, follow up on aging reports by reviewing remittance advice and consulting with Medicaid office, and post insurance payments in system-PCC.
• Prepares report of Medicaid billings, adjustments, and revenues received.
• Communicate effectively with staff, patients and insurance companies by email and telephone.
• Utilize different portal - Simple, Availity, United Healthcare, Superior, TMHP, Proclaims to manage, verify and confirm patient data, insurance eligibility and research claims.
• Collect Medicaid reimbursements by gathering, coding, and transmitting patient care information.
• Ability to accurately code and input complex data and to recognize and correct slight errors and inaccuracies.
• Resolves billing discrepancies by conducting further research and correcting errors.
• Ensures, payments by verifying accuracy of Medicaid coding.

• Built client relationships by responding to inquiries, identifying and assessing clients' needs, resolving problems, and following up with potential and existing clients.
• Following up with clients and obtaining all supporting documents for Medicaid case.
• Assist clients when they come in office with any questions or concerns they may have.
• Mailed out client's Medicaid cards to their Power of Attorney
• Scheduled and rescheduled appointments.
• Scanned in all documents and saved in appropriate file.
• Collected mail and distributed to proper location.
• Created spreadsheets for each clients bank accounts showing withdrawals over $200.00, showing ending balance of each month, and any other amounts in question.
• Notary

*Complete and process Medicaid applications-new and Annual Reviews, which entails following up with families and businesses to obtain all supporting documentation needed. Following up with Medicaid if any missing items are needed. Update Medicaid Pending log daily.

*Billing Medicaid claims and working aging reports.

Submitting 3618/3619 Medicaid forms for admissions and discharges. Posting Medicaid payments into system. Verify applied income/copay amounts are correct-MESAV needs to have correct amount.

*Handle Resident Trust Fund, which involved scanning in checks to deposit in their accounts, dealing with petty cash on daily basis, and entering withdrawal vouchers on daily basis also. Worked on spending down accounts that were over maximum allowed by Medicaid-$2000.00.

*Scanned in all cash batches into system for end of month.

*Attending Medicaid meetings every Thursday.

*Credit card and ACH payments.

*Covered front desk once a week to relieve receptionist for lunch.

*Rep Payee Applications-Social Security-helped families complete or completed for our residents.

• Complete & process Medicaid Applications for new residents and also process Medicaid Annual Reviews for current residents.
• Having 72 hour meeting with resident or family member.
• Handle Trust Fund petty cash and registers.
• Enter Medicaid Applied Income into system for billing purposes.
• Collect applied income & private pay income from resident's on monthly basis.
• Communicate with Medicaid workers to assist with process of application.
• Detailed notes are must.
• Also, communicate with family members, Adult Protective Services, and Guardians of residents to help obtain information during Medicaid application process.
• Weekly meeting with MDS nurse to keep track of RUG for billing.
• Assist residents with obtaining their ID's from DPS.
• Assist with answering phones for facility when needed.

• Responsibilities include prepping patient's charts for their upcoming appointment.
• Handle incoming records sent in electronically & or by fax machine.
• Sorting through records and delivering them to appropriate staff.
• Scan in all records into patient's chart for doctor and nurse review.
• Deal with release of information of patient records to other doctor offices or facilities.
• Call patient's regarding testing that hasn't been completed.
• Request records from other doctor offices, hospitals and facilities with proper release form.
• Send some release of information requests to Bactes, which is our copy service that handles our releases that need to go to attorneys, disability insurance companies, and for a chart that needs auditing.
• Protect security of medical records to ensure that confidentiality is maintained.
• Develop new ways in department to make our job more proficient.
• Develop specific goals and plans to prioritize, organize, and accomplish daily work.
• Providing information to supervisors, co-workers, and subordinates by telephone, in written form, email, or in person.
• Encouraging and building mutual trust, respect, and cooperation and among team members.
• Data entry of demographics Check In.

• Confirmed appointments, communicated with clients and updated client records.
• Answered central telephone system and directed calls accordingly.
• Managed multiple tasks and met time-sensitive deadlines.
• Received and routed business correspondence to correct departments and staff members.
• Corresponded with clients through email, telephone or postal mail.
• Provided clerical support to company employees by copying, faxing and filing documents.

• Insurance: Medicare, BCBS, Aetna and other insurances.
• Enter office visit charges, submit claims, correct rejections on Availity portal, and handle insurance denials.
• Work collection report.
• Make follow up calls to insurance company regarding unpaid claims.
• Obtain BCBS (through I-Exchange) and Aetna referrals.
• Obtain authorizations (RQI's) for patient's that are having Cat Scan's, MRI's, and Nuclear Stress Tests.
• Enter patient payments.
• Posting electronic Medicare payments from Availity and enter payments into system.
• Deal with patient phone calls and resolve issues.
• Mail out Medicare secondary claims.
• Verify eligibility online and calling insurance.
• Knowledge of EMR (electronic medical record).
• Fax electronically.
• Computer System: EMD's.