Margarita Caceres
Aliso Viejo,CA
Summary
Hardworking and passionate job seeker with strong organizational skills eager to secure Medical Insurance Collector / Biller position. Ready to help team achieve company goals.
Overview
19
19
years of professional experience
Work History
Medical Insurance Biller /Insurance Verification Specialist
Surgery Partners
08.2021 - Current
- Prepared billing statements for patients and verified correct diagnostic coding.
- Trained new employees on multiple medical billing programs and data entry software.
- Ensured timely reimbursement for services by submitting clean claims to insurance carriers promptly.
- Educated patients about their financial responsibilities and available payment options, helping reduce unpaid accounts receivable balances.
- Streamlined claim processing for faster payments by maintaining accurate patient records and insurance information.
- Reduced claim denials by effectively communicating with healthcare providers to obtain necessary documentation and information.
- Enhanced overall revenue collection by identifying and resolving billing discrepancies proactively.
- Boosted customer satisfaction through professional handling of patient inquiries regarding billing matters and insurance coverage.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Delivered timely and accurate charge submissions.
- Verified insurance of patients to determine eligibility.
- Responded to customer concerns and questions on daily basis.
- Handled account payments and provided information regarding outstanding balances.
- Filed and updated patient information and medical records.
- Collected payments and applied to patient accounts.
- Liaised between patients, insurance companies, and billing office.
Medical Insurance Collector
Ambry Genetics Thru Medix
10.2019 - 08.2021
- Achieved consistent success in meeting or exceeding monthly collection targets, demonstrating commitment to organizational goals.
- Improved claim resolution rates by diligently reviewing medical records and identifying errors in billing.
- Followed up on denied claims to verify timely patient payment and resolution.
- Monitored and updated claims status in claims processing system.
- Entered client details and notes into system for interdepartmental access and review.
- Researched billing errors and discrepancies to initiate corrective action.
- Responded to correspondence from insurance companies.
- Developed and documented collection procedures and policies to comply with government regulations.
- Maintained a high level of professionalism when interacting with patients, insurance company representatives, and colleagues to foster positive working relationships.
Medical Insurance Collector
Allscripts Healthcare
06.2018 - 03.2019
- Researched and resolved complex medical claims issues to support timely processing.
- Followed up on denied claims to verify timely patient payment and resolution.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Collaborated with healthcare providers to ensure accurate billing information was submitted, resulting in fewer denied or delayed payments.
- Monitored and updated claims status in claims processing system.
- Responded to customer inquiries and provided detailed account information.
- Maintained a high level of customer satisfaction by promptly addressing inquiries and resolving issues related to medical claims.
- Worked with customer to create debt repayment plan based on current financial condition.
- Contacted customers to discuss past-due accounts and negotiated payment plans.
- Listened to customers and negotiated solutions that met creditor and debtor needs.
- Researched billing errors and discrepancies to initiate corrective action.
- Responded to correspondence from insurance companies.
- Processed insurance payments and maintained accurate documentation of payments.
- Developed and documented collection procedures and policies to comply with government regulations.
- Provided exceptional customer service when addressing patient inquiries regarding billing issues or insurance coverage concerns.
- Maintained a high level of professionalism when interacting with patients, insurance company representatives, and colleagues to foster positive working relationships.
- Maintained accurate documentation of all collection activities, ensuring compliance with industry regulations and internal policies.
Medical Insurance Collector
(CHMB) California Health Medical Billing
08.2014 - 06.2018
- Researched and resolved complex medical claims issues to support timely processing.
- Followed up on denied claims to verify timely patient payment and resolution.
- Collaborated with healthcare providers to ensure accurate billing information was submitted, resulting in fewer denied or delayed payments.
- Monitored and updated claims status in claims processing system.
- Maintained accurate records of customer accounts, payments and payment plans.
Medical Insurance Collector and Medical Biller
US Renal / Ambulatory Services of America/IDS
09.2005 - 08.2014
- Entered dialysis schedules daily for 4 dialysis clinics
- Posted insurance payments to patients' accounts and sent out secondary claims for coinsurance or patient statements as applicable.
- Followed up on outstanding / unpaid and underpaid claims, filed appeals accordingly, maintained detailed documentation of actions taken on each patient account
- Worked Aging reports and spreadsheets of outstanding claims as assigned by department managers
Education
No Degree - General Education
Cerritos College
Cerritos, CA01-2008
No Degree - Billing, Medical Transcriptions & Terminology
Downey Adult School
Downey, CA01-2001
Diploma - Medical Assisting And Phlebotomy
Bryman College
Rosemead, CA 02-1994
Skills
- Medical billing software proficiency (HST, XiFin, Allscripts, QMS)
- HIPAA compliance awareness
- ICD-10 knowledge
- Bilingual (Spanish / English)
- Payment posting
- Claim submission efficiency
- Insurance appeals handling
- Teamwork and collaboration
- Billing and collection procedures
- CMS-1500 billing forms
- Verbal and written communication
- Data entry
- Insurance verification / Verification
- Attention to detail
Timeline
Medical Insurance Biller /Insurance Verification Specialist
Surgery Partners
08.2021 - Current
Medical Insurance Collector
Ambry Genetics Thru Medix
10.2019 - 08.2021
Medical Insurance Collector
Allscripts Healthcare
06.2018 - 03.2019
Medical Insurance Collector
(CHMB) California Health Medical Billing
08.2014 - 06.2018
Medical Insurance Collector and Medical Biller
US Renal / Ambulatory Services of America/IDS
09.2005 - 08.2014
No Degree - General Education
Cerritos College
No Degree - Billing, Medical Transcriptions & Terminology
Downey Adult School
Diploma - Medical Assisting And Phlebotomy
Bryman College
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