MARGARET VELARDE-WALL
Summary
PROFESSIONAL SUMMARY- MEDICAL COLLECTIONS REPRESENTATIVE Successful healthcare business office professional. Expert in medical management, medical billing, collections, credentialing, compliance, and contracts. Proven to drive revenues higher through maximizing productivity and employee relations, earning trust with all stakeholders, meeting objectives, building strong service-oriented teams, and by providing excellent personal service. SKILLS_________________________________________________ Medical terminology/ICD-10 Research and data analysis Excellent problem solver Resourceful and reliable worker Excellent written and verbal communication Epic/Centricity/Microsoft Office/CureMD. Appointment scheduling billing and collection procedures expert CPT-4 coding and HCPCS Coding Guidelines Oncology, gynecology, and anesthesia billing Commercial, government, and private insurance Results-focused medical collections professional with strength in meeting high productivity, exceed goals, and reduce company debt. Proactive leader with strengths in communication and collaboration. Proficient in leveraging team work, critical thinking and attention to detail. Knowledge to promote higher revenues. Adept at managing concurrent objectives to promote efficiency and influence positive outcomes.
Overview
22
22
years of professional experience
Work History
Senior Collections Representative
Avispa Technology
03.2020 - 10.2021
- Client is UCSF, specifically Golden Gate OB/GYN for an 18-, Achieved revenue goals each month.
- Performed claim submissions, claim edits, appeals, and lock box reconciliations with expert accuracy and effectiveness.
- Performed Cirrus claim audits, cirrus charge edits, RFI edits, and lockbox reconciliation.
- Responsible for all follow up receivables assigned on aging report associated with all commercial, government, contracted, and managed care insurance payers.
- Answered patient calls to resolve concerns routed through the ACD system using proper phone etiquette and professionalism.
- Responded to Practice Manager requests and inquiries providing accurate and update information and respond in a timely manner.
- Responsible for accuracy of input of information in CUREMD computer system.
- Reviewed and resolved outstanding account receivables through all settings of communication by accessing websites or phone and with staff, payers, and patients.
- Verified all credit balances and correct refund due and report to lead.
- Communicated with staff and manager on any outstanding issues to resolve accounts appropriately and applying correct policy and procedural issues related to Golden Gate OB/GYN, and notified manager of procedural changes and any updates or changes that occurred.
- Attended department, or other meetings as required.
Patient Account Rep
Wollenborg Michaelson
02.2019 - 04.2019
- Employment Agency.
- Managed A/R physician billing and account follow-up by applying billing practices, adhering to compliance with State and Federal guidelines, and resolving claim errors prior to submission.
- Received and processed all correspondence and phone inquiries from patients, payers or any third party in a timely and professional manner.
- Resolved accounts by contacting third party payer organizations after thorough investigation and taking steps to identify erroneous denials or short payments.
- Resolved credit balances that are due to patients and payers.
- Appealed all short and non-payment accounts by written correspondence.
- Worked collaboratively with other team members and shared knowledge and best practices.
Account Billing Rep
Berkeley Emergency Medical Group
San Ramon
12.2018 - 01.2019
- (ER) A/R Physician billing and account follow-up in compliance with State and Federal guidelines through thorough examination of Explanation of Benefits (EOBs) and other communications.
- Received and processed all correspondence and phone inquiries.
- Appeals expert for all accounts for short payments and denials for all insurance types.
- Familiar with all payor types, (Medicare, Medi-Cal, Commercial and managed care).
- Familiar with CPT, HCPCS, EDI, and ICD-10 coding.
Accounts Receivable Specialist II
McKesson Provider Technologies
Novato
11.2012 - 11.2016
- Managed a high-volume of inbound insurance company inquiries.
- Gathered and verified all required patient information for resubmissions and appeals.
- Accurately documented, researched, and resolved claims issues through thorough researching of EOBs.
- Reconciliation of accounts.
- Met or exceeded service and quality standards.
- Reduced A/R balance in outgoing system by more than $300,000.
- Wrote and submitted appeals with a 70% effective rate.
home
Pittsburg
09.2006 - 11.2014
- Caregiver for Housebound Family Member, Provided personal care for my disabled mother.
- Managed healthcare needs regarding physicians, social workers, and therapists.
Medical Collections Specialist IV
Marin Medical Practice Concepts
Novato
03.2008 - 03.2010
- Achieved 32% increase in collections in one year by engaging in communications or filing appeals.
- Reduced aging of old accounts from more than 24 months to a maximum of 90 days by relentless pursuit of old and current claims payments.
- Met or exceeded service and quality standards every review period.
- Created guidelines for streamlining the billing processes for various providers.
- Responded professionally to 70+ inbound patient, provider, and insurance calls daily.
- Resolved billing and collections issues by analyzing EOBs and other supporting documents.
- Wrote and submitted appeals with a 75% effective rate.
- Accurately documented, researched, and resolved claims issues.
- Created reports for clients and management.
Billing/Collections Manager
Gladys May Bennett, M
Alameda
02.2000 - 09.2006
- Consistently complied with applicable laws and regulations and ensured physician adhered to Medicare and Medicaid regulations.
- Oversaw private and MCR billing and verified that proper procedures were followed.
- Collected 100% of billed charges.
- Insurance verification.
Education
MBA - Healthcare Administration
University of Phoenix Online
01.2012
Bachelor of Science - Criminal Justice
University of Phoenix Online
01.2011
Associate of Arts - Criminal Justice
University of Phoenix Online
01.2008
Skills
- Collections best practices
- Payment acceptance
- Proficiency in CURE MD
- Performance improvement techniques
- Investigative research
- Billing dispute resolution
- Adjustment posting
- Bill processing
- Investigation due diligence
Timeline
Senior Collections Representative
Avispa Technology
03.2020 - 10.2021
Patient Account Rep
Wollenborg Michaelson
02.2019 - 04.2019
Account Billing Rep
Berkeley Emergency Medical Group
12.2018 - 01.2019
Accounts Receivable Specialist II
McKesson Provider Technologies
11.2012 - 11.2016
Medical Collections Specialist IV
Marin Medical Practice Concepts
03.2008 - 03.2010
home
09.2006 - 11.2014
Billing/Collections Manager
Gladys May Bennett, M
02.2000 - 09.2006
MBA - Healthcare Administration
University of Phoenix Online
Bachelor of Science - Criminal Justice
University of Phoenix Online
Associate of Arts - Criminal Justice
University of Phoenix Online