Lyanna Rodriguez
Brooklyn
Summary
Medical Billing and Coding Specialist with 11+ years of extensive expertise in converting complex medical data into precise billing information, ensuring compliance with industry standards. Proficient in HCPCS, CPT, and ICD-10 coding, with a proven track record of optimizing insurance claim submissions and managing appeals to enhance operational efficiency and maximum reimbursement.
Overview
13
13
years of professional experience
Work History
Procedural Billing Specialist l
Mount Sinai
New York
03.2025 - Current
- Reviewed insurance claims for completeness and compliance with regulations.
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Reviewed and processed patient authorization requests for various procedures.
- Collaborated with healthcare providers to gather necessary documentation promptly.
- Tracked authorization statuses using electronic databases or manual filing systems.
- Created spreadsheets utilizing Microsoft Excel for tracking authorization status updates from payers.
- Ensured timely submission of accurate documentation to support payment of services rendered by providers.
- Prepared appeal letters on behalf of clients when necessary to resolve disputes with insurers.
Orthopedic Medical Billing and Coding Specialist(Spine Surgeon)
SpineCareOfNY
New York
06.2017 - Current
- Analyze patient records, translating complex medical terminology into accurate diagnosis and procedural data, ensuring compliance with CMS and state guidelines.
- Expedite surgical authorization by providing accurate CPT codes, significantly reducing patient care delays and improving overall efficiency.
- Consults with medical specialists to resolve discrepancies, ensuring accurate interpretation of patient data and maintaining high-quality coding standards.
- Prepare claims for accurate and timely submission to both patients and third-party payers (e.g., commercial payers, HMOs, and government payers).
- Post electronic and manual payments, denials and adjustments to patient accounts with attention to detail.
- Serve as the primary point of contact for patients regarding their billing inquiries ensuring they understand their financial obligations.
- Meticulously review EOBs from various insurers, initiating appeals for denials to maximize reimbursement and minimize revenue loss.
- Prepares and effectively monitors A/R resulting in payment; resulting in less delays for reimbursement.
Orthopedic Medical Biller for Physicians Assistant
SpineCareOfNY
07.2016 - 05.2017
- Collaborated with insurers and healthcare providers to expedite claim processing and payments.
- Verified insurance benefits for HMO, Medicare and Commercial payers.
- Drafted appeal letters to contest claim denials, achieving successful overturns.
- Ensured that A/R payments are current and all delinquent accounts are being followed up on in a timely fashion.
- Optimized accounts receivable management using BrickMed, generating detailed aging reports and implementing proactive measures to reduce outstanding balances and improve cash flow.
Medical Billing Supervisor
KLM EYES MDs/BROOKLYN EYE SURGERY CENTER
Brooklyn
02.2014 - 06.2016
- Led a team of 3 in the billing department, optimizing daily operations and improving efficiency in insurance claim submissions and follow-ups.
- Prepared and submitted clean claims to various insurance companies, either electronically or by paper.
- Resolved complex claim issues, improved resubmission accuracy, and established robust follow-up procedures, boosting revenue recovery.
- Set-up practice management software for submission of electronic claims to clearinghouse.
Administrative Assistant/Front Desk
01.2013 - 01.2014
- Managed diverse administrative tasks, including appointment scheduling, document handling, and patient file management, ensuring smooth office operations.
- Streamlined document processing by implementing efficient scanning and filing systems, improving information retrieval and office productivity.
- Coordinated seamlessly with staff to manage appointments, update calendars, and ensure smooth communication across departments.
Education
Medical Billing and Coding Specialist Certification Program -
Kingsborough Community College
Brooklyn, NYBachelors of Science Degree - Business Management
The City University of New York, College of Staten Island
Staten, NYCertified Medical Billing And Coding Specialist (CBCS) -
National Healthcareer Association
Skills
- Medical claims submission
- Confidentiality
- Payment posting
- Accounts receivable
- Insurance processing
- Data entry
- Insurance verification
- Insurance negotiation
- Surgical coding
- Appeals management
- Patient billing
- Claim follow-up
- SRS EHR Software
- Epic
- BrickMed
Personal Information
Title: Medical Billing and Coding Specialist
Timeline
Procedural Billing Specialist l
Mount Sinai
03.2025 - Current
Orthopedic Medical Billing and Coding Specialist(Spine Surgeon)
SpineCareOfNY
06.2017 - Current
Orthopedic Medical Biller for Physicians Assistant
SpineCareOfNY
07.2016 - 05.2017
Medical Billing Supervisor
KLM EYES MDs/BROOKLYN EYE SURGERY CENTER
02.2014 - 06.2016
Administrative Assistant/Front Desk
01.2013 - 01.2014
Medical Billing and Coding Specialist Certification Program -
Kingsborough Community College
Bachelors of Science Degree - Business Management
The City University of New York, College of Staten Island
Certified Medical Billing And Coding Specialist (CBCS) -
National Healthcareer Association