Lourda Robles
Happy Valley
Summary
Detail-oriented Revenue Cycle Management Specialist experienced in resolving billing issues, managing claims denials, and overseeing accounts receivable. Delivered effective solutions through a strong understanding of medical terminology, ICD-10 coding, and Epic billing software. Focused on fostering collaboration and training while driving continuous improvement initiatives.
Overview
11
11
years of professional experience
Work History
REVENUE CYCLE SPECIALIST
Providence Health and Services/ R1 Revenue Cycle Management
Portland
03.2020 - Current
- Follow-up with Commercial Insurances regarding denials or pending claims, focus on accounts over 20k
- Managed patient accounts, including billing and collections of payments.
- Investigated and resolved billing issues, obtained correct billing information to prevent recurring errors.
- Account auditing to coding review, EFT payment posting, contractual adjustments, final adjustments and offsets, recoupments, ensure accuracy and completeness
- Work Rejections WQ's, Commercial WQ's, 20k WQ's for Alaska region and Oregon region, Washington region, California region and Montana region
- Workers Comp claims, Veterans claims, and Motor Vehicle accidents Claims denials and appeals
- Monitored unpaid claims to facilitate prompt appeal submissions.
- AR reports, Daily reports, Priority reports, and Aged Reports on accounts over 60,90 & 120 days
- Monitored changes in healthcare regulations and policies that impact the revenue cycle process.
- Ensured compliance with HIPAA regulations governing patient privacy rights.
- Reconciled discrepancies between invoices from third-party payers.
- Performed detailed analyses of financial reports to identify and address potential revenue cycle deficiencies.
- Implemented corrective action plans when errors were identified in billing processes or procedures.
BILLING SPECIALIST
ZoomCare
11.2018 - 02.2020
- Request retros and request Authorizations for Workers Comp, MVA and VA claims
- Focused on accounts in the AR over 60,90, & 120 days (reduced AR over 60, 90, and 120 days)
- Focused on accounts in AR over 60, 90, and 120 days, achieving reduction in aged receivables.
- Follow-up with MVA adjusters, and Worker Comp claims adjusters, verified coverage, claim status and payments status
- Follow-up with MVA adjusters, and Worker Comp claims adjusters, verified coverage, claim status and payments status
- Processed urgent requests from supervisor and law firm to ensure timely responses.
- Resolved customer inquiries related to billing quickly and effectively.
- Managed escalated billing dispute cases, resolving issues and ensuring customer satisfaction.
- Provided timely follow up on past due accounts using phone calls, emails or letters.
- Demonstrated ability to identify errors or inconsistencies in data entry quickly and efficiently.
- Maintained accurate and complete billing system and process.
- Utilized strong organizational skills to manage daily workflow for billing operations.
- Prepared various reports such as aging report, revenue report and payment analysis report.
- Expertise in reconciling discrepancies between invoices, payments, credits and other documents.
- Created and implemented billing processes that enhanced accuracy and streamlined operations.
- Prepared itemized statements, bills, and invoices, due for services rendered.
PATIENT ACCOUNT MANAGER
Zybetx
San Diego
11.2015 - 07.2018
- Managed two clinics; assigned to an Oncology clinic and Gastroenterology clinic
- Oversaw financial operations, patient care, and managed billing, collections, and administrative tasks to ensure efficient clinic function.
- 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
- Ensured timely processing of EFT payments to maintain cash flow.; and check posting, contractual adjustments, NRP balance to secondary or self-pay
- Filed appeals for denied insurance claims to secure reimbursements, focused on accounts with an outstanding balance over 60, 90, and 120 days and payment resolution
- Generated detailed month-end reports to assess financial performance., Developed AR reports for tracking patient billing and collections., Produced yearly financial reports to evaluate annual performance. and attended monthly meetings with physicians; billed invoices for billing services
- Processed and addressed urgent medical insurance requests
- Monitored collection activities and took corrective actions to improve outcomes.
- Assisted patients with setting up payment plans or applying for financial assistance programs when needed.
- Implemented procedures that streamlined delinquent account collections, reducing bad debt write-offs and improving payment recovery.
- Maintained a thorough understanding of HIPAA regulations to ensure compliance in all aspects of patient account management.
- Analyzed monthly financial statements for accuracy prior to submitting them for review by senior leadership.
- Data entry scanned medical records, created patient registration, verified eligibility
- EFT Payment posting; and check posting, contractual adjustments, NRP balance to secondary or self-pay
- Month End reports, AR reports, Yearly reports and attended monthly meetings with physicians; billed invoices for billing services
- Utilized customer service skills to communicate clearly with patients about account balances, payment plans, and insurance coverage, enhancing patient satisfaction.
- Analyzed collection reports to assess recovery efforts and outstanding balances. determining status of collections and amount of outstanding balances.
- Evaluated financial reporting systems, accounting and collection procedures, and investment activities and made recommendations for changes to procedures, operating systems, budgets and other financial control functions.
Education
Associate of Science -
DeVry University
Portland, OR 07.2026 - 07.2026
BACHELOR OF SCIENCE - HEALTH MANAGEMENT
University of Phoenix
San Diego, CAHEALTHCARE INFORMATION TECHNOLOGY -
Comprehensive Training Systems
San Diego, CAGED -
Visalia Adult School
Visalia, CAMEDICAL ASSISTANT DIPLOMA -
Concorde Career College
San DiegoSkills
- Revenue management
- Claims processing
- Medical billing
- Insurance coordination
- Denial resolution
- Healthcare finance
- Compliance management
- HIPAA regulations
- Collection procedures
- Patient registration
- Financial systems
- Microsoft Office Suite
- Analytical skills
- Problem-solving abilities
- Organizational skills
- Financial systems
- Problem-solving abilities
Timeline
Associate of Science -
DeVry University
07.2026 - 07.2026
REVENUE CYCLE SPECIALIST
Providence Health and Services/ R1 Revenue Cycle Management
03.2020 - Current
BILLING SPECIALIST
ZoomCare
11.2018 - 02.2020
PATIENT ACCOUNT MANAGER
Zybetx
11.2015 - 07.2018
BACHELOR OF SCIENCE - HEALTH MANAGEMENT
University of Phoenix
HEALTHCARE INFORMATION TECHNOLOGY -
Comprehensive Training Systems
GED -
Visalia Adult School
MEDICAL ASSISTANT DIPLOMA -
Concorde Career College