Lorena Boyer
Casa Grande,AZ
Summary
Meticulous Medical Biller/Eligibility Specialist offering 22 years of comprehensive experience in Medicare and Medicaid. Comfortable working independently or as part of supportive team. Core competencies include knowledge of medical insurance and payments/invoicing.
Overview
22
22
years of professional experience
1
1
Certification
Work History
SHIP/SMP Coordinator
Pinal-Gila Council For Senior Citizens
Casa Grande , AZ
04.2023 - 01.2024
- Maintained current knowledge of all applicable laws governing the Medicare program.
- Provided detailed explanations of Medicare benefits, services, and coverage options to customers.
- Researched customer inquiries regarding eligibility for Medicare programs.
- Participated in training sessions designed to increase understanding of new policies or procedures related to enrollment processes.
- Assisted customers with completing the application process for Medicare enrollment.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Conducted interviews with applicants, explaining benefits process and which programs were available.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
- Cooperated with Medicare, Medicaid and private insurance providers to resolve billing issues.
- Assisted clients in completing forms related to their Medicaid application process.
- Reviewed insurance policies to ensure compliance with existing regulations.
- Provided guidance to customers regarding available insurance plans and their benefits and limitations.
- Worked with cross-functional teams to achieve goals.
Eligibility/Collections Specialist
Valley Heart Associates
01.2020 - 01.2022
- Daily task of verifying medical insurance and inputting details along with copay estimates
- Submitting requests for pre-authorization for medical procedures from correct primary care offices, entering details into chart, and notifying patient or the copay, authorization approval/disapproval
- Follow up on Accounts Receivable's outstanding accounts and claims with insurances such as Medicaid, Blue Cross Blue Shield, United etc
- Contact insurance companies regarding account balances, file grievances on denied claims
- Utilize Accounts Receivable aging reports to track missing or incorrect payments
- Contact insurance company to verify patient benefits and consult with patient with requesting benefits details
- File appeals when insurance company does not pay properly.
Eligibility Specialist
Community Bridges Inc
01.2019 - 01.2020
- Input all gathered information and researched data on applicants into computer system using appropriate resources
- Followed guidelines when reviewing applicant data to determine eligibility of members insurance benefits
- Identified areas of personnel deficiency and took necessary action for correction
- Assured timely verification of insurance benefits.
Accounts Receivable
A&M Corson's Aqua Value
01.2013 - 01.2019
- Responded to customer requests via telephone and email
- Entered details such as payments, account information and call logs into the computer system
- Handled Payroll, verified lunch pay in and pay outs
- Supported Chief Operating Officer with daily operational functions
- Prepared receivables, invoices and bank deposits
- Resolved valid or authorized deductions by entering adjusting entries
- Posted customer payments by recording cash, checks and credit card transactions
- Computed taxes owed by applying prescribed rates, laws and regulations
- Generated financial statements and facilitated account closing procedures each month
- Posted revenues by verifying and entering transactions from lock box and local deposits
- Compiled general ledger entries on a short schedule with nearly 100% accuracy.
Billing Specialist
PHI Air Medical LLC
01.2012 - 10.2012
- Accurately posted and sent out all medical claims
- Identified errors and re-filed denied or rejected claim in a timely manner
- Prepared billing statements for patients, ensuring correct diagnostic coding
- Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes
- Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts
- Ensured HIPAA compliance.
Billing Specialist
OMNI Flight Helicopters
01.2006 - 01.2011
- Generated and submitted invoices based upon financial schedule
- Developed and implemented improvements to billing system to maximize efficiency, reduce delinquency and increase accuracy
- Administered assessments and developed academic goals based on specific disabilities and barriers to learning
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances
- Collected and processed co-payments and out-of-pocket charges
- Processed monthly reports for department performance
- Executed billing tasks and recorded information in company databases
- Processed payment via telephone and in person with a focus on accuracy and efficiency
- Managed invoicing and payment processing operations
- Developed rapport with clients and vendors to cultivate loyalty and satisfaction
- Monitored outstanding invoices and performed collections duties
- Reconciled past due accounts
- Handled account payments and provided information regarding outstanding balances
- Managed a multiple of AR accounts, working directly with management personnel.
Education
High School Diploma -
Belle Chasse High School
Belle Chasse, LA05-2000
Skills
- Data Entry
- Professional Networking
- Medical Terminology
- Insurance Verification
- Medical Billing
- Multitasking and Organization
- HIPAA Compliance Certification
- Account Reconciliation
- Billing and Collection Procedures
- Commercial and Private Insurance
- Insurance Claims
- Insurance Billing
- Claim Review
- Payment Posting
- Insurance Terminology
- Medicaid Knowledge
- Coverage and Authorizations
Certification
I have a Level 1 Clearance Card that is active until 2025.
I am also a Military Veteran.
References
References available upon request.
Timeline
SHIP/SMP Coordinator
Pinal-Gila Council For Senior Citizens
04.2023 - 01.2024
Eligibility/Collections Specialist
Valley Heart Associates
01.2020 - 01.2022
Eligibility Specialist
Community Bridges Inc
01.2019 - 01.2020
Accounts Receivable
A&M Corson's Aqua Value
01.2013 - 01.2019
Billing Specialist
PHI Air Medical LLC
01.2012 - 10.2012
Billing Specialist
OMNI Flight Helicopters
01.2006 - 01.2011
High School Diploma -
Belle Chasse High School
I have a Level 1 Clearance Card that is active until 2025.
I am also a Military Veteran.
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