Lourda Robles
Portland,OR
Summary
Bilingual Account Representative with (10) years’ medical billing experience. Strong ability to multi-task, detail oriented, analytical skills, strong ability to work without Supervision. Work well in a fast-paced work environment, and strong ability to work well under pressure with the ability to perform job duties effectively and efficiently, grasp new ideas and concepts, great problem solver. Enthusiastic, highly motivated professional, with great customer service and management experience, great leading skills, and great team player, enjoys being productive and completing assignments in a timely manner.
Overview
10
10
years of professional experience
Work History
Billing Representative
Providence Health and Services
03.2020 - Current
- Follow-up with Commercial Insurances on Accounts regarding denials or pending information, or accounts over 20k, resolve billing issues, and payment resolution
- AR reports, Daily reports, Priority reports, and Aged Reports on accounts over 60,90 & 120 days
- Investigate resolve billing issues, Obtain correct billing information to bill the correct payer, correct claims address, or payer ID, correct auth, new auth, retro, correct member ID
- Account auditing to coding review, EFT payment posting, contractual adjustments, final adjustments and offsets, recoupments, ensure accuracy and completeness
- Patient registrations, smart text letter requesting information from patients', Coverage updates, COB
- Fax information requested Medical Records and itemized statements
- Work Rejections WQ’s, Commercial WQ’s, 20k WQ’s for Alaska region and Oregon region, Washington region, California region and Montana region
- Work Reports assigned by supervisors, train new employees, team projects and shadow new employees
- Workers Comps claims, Veterans claims, and Motor Vehicle accidents Claims denials and appeals
- Request retros and request Authorizations for Workers Comps, MVA and VA claims
Billing Specialist
ZoomCare
12.2018 - 02.2020
- Managed Motor Vehicle Accident claims and Workers Comp claims for 32 clinics
- Focused on accounts in the AR over 60,90, & 120 days (reduced AR over 60, 90, and 120 days)
- Appealed denied claims and reconcile payments for accounts with outstanding balances
- Follow-up with MVA adjusters, and Worker Comps claims adjusters, verified coverage, claim status and payments status
- Follow-up with patients for first party insurance information, attorney information, adjusters
- Effective verbal, and written communication with patients and Claims adjusters via email,fax,calls
- Assisted patients and claims adjusters with any questions, concerns, and information requested
- Processed and addressed urgent request by supervisor, and law firm
Patient Account Manager
Zybex
11.2015 - 06.2018
- Managed two clinics; assigned to an Oncology clinic and Gastroenterologist clinic
- Oversed financial aspects, patient care and managed billing, collections and related administrative tasks
- Ensure accurate fee posting Tele-med fees, Professional fees, Facility fees, and State of California inmate fees, billed commercial insurances, Medicare, Medi-Cal and Correctional care
- Data entry scanned medical records, created patient registration, verified eligibility
- EFT Payment posting; and check posting, contractual adjustments, NRP balance to secondary or selfpay
- Appealed denials, focused on accounts with an outstanding balance over 60, 90, and 120 days and account resolution payments
- Month End reports, AR reports, Yearly reports and attended monthly meetings with physicians, billed invoices for billing services
- Assisted patients' regarding any medical billing questions
- Assisted providers with searching CPT codes, Medicare fee-for-schedule, Contracts, and Credentialing, portal registrations
- Processed and addressed urgent medical insurance requests
Education
Bachelor of Science - Health Management
University of Phoenix
San Diego, CA05.2025
Healthcare Information Technology
Comprehensive Training Systems
San Diego, CA08.2015
GED - undefined
Visalia Adult School
Visalia, CA01.2013
Medical Assistant Diploma - undefined
Concorde Career College
San Diego, CA09.2008
Skills
- Medical Terminology and ICD-10 knowledge
- Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Microsoft Office, Epic billing software, computer skills
- Bilingual English and Spanish, Written and Verbal Communication skills
- Attention to detail, teamwork and collaboration skills
- Leadership skills, time management, and organizational skills
Timeline
Billing Representative
Providence Health and Services
03.2020 - Current
Billing Specialist
ZoomCare
12.2018 - 02.2020
Patient Account Manager
Zybex
11.2015 - 06.2018
Bachelor of Science - Health Management
University of Phoenix
Healthcare Information Technology
Comprehensive Training Systems
GED - undefined
Visalia Adult School
Medical Assistant Diploma - undefined
Concorde Career College