Luis Sobalvarro

• Reviewed and corrected discrepancies in account balances regularly.
• Maintained accurate records of credit balances in the billing system.
• Collaborated with finance team to ensure compliance with policies.
• Assisted in generating reports on outstanding credit balances monthly.
• Coordinated with insurance providers to resolve payment issues promptly.
• Collaborated with other departments to ensure proper resolution of issues involving credits or refunds.
• Identified trends in customer payment patterns that could indicate potential problems.

• Analyzed EOBs to enhance collections strategies.
• Specialized in UB claim forms interpretation.
• Ensured HIPAA compliance across documentation processes.
• Managed Medicare and Medi-Cal HMO collections efficiently.
• Conducted detailed audits to identify root causes of denials.
• Prioritized tasks for timely completion of assignments.
• Demonstrated attention to detail in appeals and EOB reviews.

• Medicare HMO and Medi-Cal HMO collections experience
• Understanding UB claim forms
• Knowledge of HIPAA compliance
• Strong analysis of EOBs for collection purposes
• Extremely detail oriented when working on appeals or reviewing EOBs
• Ability to multitask with short timelines
• Ability to prioritize, organize work, and complete assignments in a timely manner
• Excellent interpersonal skills

• Conducted precise audits of patient accounts to verify accuracy of charges and adjustments.
• Maintained proper aging of accounts receivable to facilitate timely collections.
• Monitored payments to ensure compliance with agreed fee schedules.
• Contacted patients and insurance carriers regarding delinquent accounts for resolution.
• Negotiated payment plans, enhancing recovery of unpaid balances.
• Demonstrated exceptional skill in addressing sensitive financial matters with patients.

• Answer inquiries by full regarding basis of patient balances
• Identifies Problem accounts with payers; investigates and corrects errors
• Follows up on missing patient account information and resolves past due patient accounts.
• Performed inbound and outbound functions regarding account balances
• Billing/ Insurance follow up for facility (UB04) and physician (1500) claims
• Empower to adjust accounts based on case by case basis
• Contacts responsible party to resolve delinquent accounts; prepares payment plans and monitors adherence to plans by responsible party; directs accounts to outside collection agencies when necessary. Posts data; verifies and performs mathematical computations.

• Followed up on all claims from billing through final resolution
• Reviewed and prepared claims for manual and or electric billing submission
• Identified billing errors for correction and resubmit claims to insurance carriers
• Followed up on payment errors, low reimbursement, denials, etc.
• Reviewed insurance EOBs and initiated appeals as necessary
• Printed and mailed UB04s or HCFA 1500s as necessary for account resolution.

Performed daily downloads, reconciliations to electronic billing system (EPIC)

· Transmitted/released claims at a minimum daily productivity guideline

· Worked assigned claims daily-resolving edits, validating claim, or placing on hold · Followed-up on all assigned held claims or unreleased claims.

· Billed claims via electronic billing system.

· Reviewed same day and 72-hour admission report to determine if combining accounts · Filed adjusted billings based on audits and or changes in diagnosis or DRG.

· Appropriately documented electronic billing system and/or patient accounting system.

· Worked inpatient hospital accounts, works authorizations for inpatient accounts

· $200K inpatient high dollar claims and knows expected reimbursements per contracts leading to $30-40k

· Worked commercial and Medi-Cal secondary insurance payers

· Adjusted aged accounts back to 2011 and contacts AIM to verify if authorizations have been given

· Disputed denial retro authorizations with affidavit denial and medical records

· Changed DRG and revenue codes for adjustments for Providence accounts/ claims to reprocess

Reviewed correspondence, verify payment or denial, provided additional info such as full medical records

· Worked Scans, personal injuries and worker’s comp

· Handled cases on lien basis with attorneys

· Worked negotiations

· Follow up with insurance companies and attorneys regarding patient status and case status

· Explained account process with patients and reviewed hard copy EOB’s

· Worked only PPO’s (Aetna, Blue Shield, Blue Cross, SAG)

· Sent monthly follow up statements to patients

· Processed refunds and sent information to cash posting departments

· Types of procedures: MRI’s, Epidurals, CT Scans, MRA’s, Neuro Science

Appeals for facility charges using UB04

· EOB denials working a load of 45 a day and appealed claims

· Contacted various insurances to resolve various denials and issues

· Provided professional billing services for UCLA Medical Center

· Customer Service duties including but not limited to answering phones, filing, faxing, scanning, and answering customer questions and concerns · Utilized software system: Medisoft

Customer Service duties including but not limited to answering phones, filing, faxing, scanning, and answering customer questions and concerns, document correspondence into system.

· Patient charts pick up from various departments

· Assembled OP & GI packets

· Greeted Customers