Lynette Plaza

• Prepared and submitted billing data and medical claims to Medicare using DDE system, ensuring timely processing and reimbursement.
• Submitted appeals to Medicare using Connex, facilitating resolution of denied claims.
• Managed timely submission of Notices of Admission (NOAs). and verifying acceptance of NOAs.
• Identified claims discrepancies due to partial and/or overpayments, contributing to accurate financial reporting and claim adjustments.

• Research claim rejections and take corrective actions to ensure timely resolution.
• Validated insurance information through online systems.
• Corrected and adjusted patient demographics in Epic system to maintain accurate records.

• Appealed underpaid claims electronically and on paper for multi-specialist group, ensuring accurate reimbursement across various specialties.
• Appealed underpaid claims both electronic and on paper for large multi-specialist group including PCP, Internal Medicine, Pediatrics, OB GYN, Podiatry and Ortho.
• Identified underpayments based on contract rates and analyzed trends to inform future billing processes.
• Sent corrected claims electronically and on paper.
• Confirmed patient insurance eligibility via online systems
• Utilized provider portals to resubmit requested medical records.
• Processed claims for refunds for commercial and government payers, ensuring timely resolution and compliance with managed care requirements.
• Adjusted and followed up on IA requests within 24-48 hours after email receipt.

• Manual cash posting for all insurances and self pays.
• Managed payer and electronic transmission rejections.
• Review, research, and take necessary actions to correct/resolve charge discrepancies, adjustments, and refunds.
• Responsible for payer or electronic transmission rejections.
• Updated and corrected patient demographics in the MedWare system. in MedWare system.
• Conducted follow-up on under-payments from third-party payers to secure owed revenue.
• Reviewed and resolved charge discrepancies, adjustments, and refunds to maintain billing accuracy.

• Resolved charge discrepancies, adjustments, and refunds through thorough review and research, ensuring accurate billing.
• Followed up on under-payments from third-party payers.
• Managed rejections of payer or electronic transmissions, facilitating prompt corrections and resubmissions.
• Posted cash payments accurately to patient accounts. both paper and electronic (835).
• Verify patients' insurance policies.
• Add or correct patient demographics in ECW system.

• Handled specialty billing for community clinic services to facilitate timely reimbursement.
• Resolved collection issues across self-pay, commercial insurances, Medicaid, and Medicare accounts, improving overall recovery rates.
• Executed cash posting for both paper and electronic (835) transactions, ensuring accuracy in account reconciliation.

• Specialty billing for Home Health Care, Long Term Care, and Self-Pay.
• Resolve collection issues for Commercial Insurances, Long Term Care and all Medicaid accounts.
• Resolved collection issues for commercial insurances, long term care, and Medicaid accounts, enhancing revenue recovery.
• Delivered exceptional customer service to patients, outside vendors, and health care providers, fostering strong relationships.
• Review, research, and take necessary actions to correct/resolve charge discrepancies, adjustments and refunds.
• Reviewed and researched charge discrepancies, adjustments, and refunds, ensuring accurate billing and prompt resolution.
• Posted cash payments through both paper and electronic methods to ensure accurate financial records.
• Proficient in Allscripts, Novius, PCAce32.

High school or equivalent in General Studies