LISSETTE VERONICA CARRILLO
McAllen,TX
Summary
Experienced bilingual healthcare revenue cycle professional with over 20 years of experience in medical office operations, insurance eligibility verification, accounts receivable, and denial management. Extensive knowledge of insurance benefits, reimbursement guidelines, and payer requirements including Medicare, Medicaid, commercial insurance, and workers’ compensation. Current DHR Health revenue cycle employee with internal transfer from Commercial Collections to Denials Management Specialist.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Denials Resolution & Management Specialist
DHR Health
McAllen, TX
10.2024 - 02.2026
- Transferred internally to the Denials and Appeals Team to manage complex reimbursement issues and denied claims.
- Investigated and resolved insurance claim denials, underpayments, and reimbursement discrepancies.
- Prepared and submitted formal appeals with supporting documentation including medical records, itemized billing, and payer requirements.
- Analyzed reimbursements to ensure compliance with managed care contracts, Medicare, Medicaid, commercial insurance, and workers’ compensation guidelines.
- Corrected billing errors and resubmitted claims to ensure accurate adjudication by insurance carriers.
- Communicated with payors, providers, and internal departments to resolve claim discrepancies.
- Monitored payer denial trends and reported recurring issues affecting reimbursement.
- Maintained accurate account documentation and ensured HIPAA compliance.
Commercial Collector Specialist
DHR Health
McAllen, TX
10.2017 - 10.2024
- Managed insurance accounts receivable for commercial, workers’ compensation, and liability payers.
- Followed up on an average of 45 accounts daily to ensure timely reimbursement and claim resolution.
- Verified insurance eligibility, coverage details, and claim status through payer portals and phone verification.
- Utilized AEOS system and payer portals including TMHP, FISS, and MyAbility to obtain claim and eligibility information.
- Coordinated with coding departments regarding CPT, HCPCS, modifiers, and diagnosis codes when resolving claim issues.
- Requested medical records and documentation to support claims and appeals.
- Maintained communication with insurance carriers to expedite claim resolution.
Office Supervisor
AeroCare Holdings
Miami, FL
01.2015 - 10.2017
- Directly supervise staff to maximize individual potential
- Maintain working knowledge of home equipment, insurance guidelines, eligibility, and reimbursements
- Responsible for monthly reports to increase revenue by resolving holds on patient accounts
- Orient and train new employees
- Effectively supports office manager with all administrative tasks
- Resolve patient complaints
- Monitor staff calls for quality assurance
Office Supervisor / Physicians Director
Pulmonary Physicians of South Florida
South Miami, FL
10.2004 - 01.2015
- Supervised and maintained working knowledge of all work stations including but not limited to check in, check out, insurance verifications, medical records, outpatient schedulers and office schedules
- Maintained staff by recruiting, selecting, orienting, and training employees
- Provided support to office manager with all administrative tasks
- Implemented new policies and procedures to improve office efficiency
- Conducted yearly staff evaluations
- Generated office and physician schedules
- Audited office and hospital billing
- Monitored daily charges, payments and closing
- Handled complaints from patients and staff
- Reviewed and monitored maintenance of all office equipment
- Assisted with employee payroll
- Served as a liaison between physicians and employees
Education
High School Diploma / GED -
Skills
- Insurance Eligibility Verification
- Referral & Authorization Processing
- Revenue Cycle Management
- Denial & Appeals Resolution
- Medical Billing & Reimbursement
- CPT / ICD-10 / HCPCS Knowledge
- Medical Terminology
- TMHP & Insurance Portal Verification
- Patient Financial Responsibility
- Microsoft Office (Word, Excel, Outlook)
- Customer Service & Communication
Certification
- HIPAA Compliance
- OSHA Regulations
- HME Certification
- Medical Terminology
- Certified NextGen Administrator
Languages
Bilingual: English / Spanish
Timeline
Denials Resolution & Management Specialist
DHR Health
10.2024 - 02.2026
Commercial Collector Specialist
DHR Health
10.2017 - 10.2024
Office Supervisor
AeroCare Holdings
01.2015 - 10.2017
Office Supervisor / Physicians Director
Pulmonary Physicians of South Florida
10.2004 - 01.2015